Immunohistochemistry

AADA Advocacy to EviCore Leads to Positive Changes on Immunohistochemistry (IHC) Policy

In response to AADA advocacy, EviCore acknowledged that it has updated its IHC guidelines used by several health plans. The AADA continues to advocate to EviCore and changes to date include:

• It removed management of the skin-related ICD codes from their IHC policy, so these codes will revert to being automatically paid as of March 15, 2024: C44.X, D03.X, D04.X, D22.X, D23.X, D48.5, L57.0, L82.X

• Further, EviCore is not enforcing the policy language stating that testing will not be reimbursed in scenarios where a diagnosis can be made without the use of an IHC stain.

• EviCore expects to publish the revised IHC policy by 1/1/2025 pending internal review.

EviCore’s lab management guidelines are used by the following carriers:

• BCBS AZ

• BCBS IL (Medicare/Medicaid plans)

• BCBS MN

• BCBS MT (Medicare/Medicaid plans)

• BCBS ND

• BCBS NM (Medicare/Medicaid plans)

• BCBS OK (Medicare/Medicaid plans)

• BCBS TX ((Medicare/Medicaid plans)

• BCBS TN

• Blue Cross Complete MI

• Cigna Plus Oscar

• Connecticare

• Health Alliance Medical Plans

• Healthfirst

• Highmark

• Horizon

• Independence Blue Cross

• Johns Hopkins HealthCare

• Mass General Brigham Health

• Meridian, A WellCare Company

• Oscar (AR, IL, NE)

• Priority Health

• Prominence Health Plan

• Rocky Mountain Health Plans

• SummaCare (Apex)

• Wellcare

• Wellmark (BCBS IA & SD)

• WellSense Health Plan

AADA members are encouraged to report denials to privatepayer@aad.org.