Prior authorization request form Form

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 1 (401) 274-4848 WWW.BCBSRI.COM

EFFECTIVE DATE: 02|21|2011 POLICY LAST UPDATED: 10|04|2023

OVERVIEW The “Know Error®” system is a DNA test used to verify the identity of biopsy specimens. The Know Error® test is thought to prevent misidentification errors in the biopsy evaluation process.

MEDICAL CRITERIA Not applicable

PRIOR AUTHORIZATION
Not applicable

POLICY STATEMENT Medicare Advantage Plans and Commercial Products The Know Error® system is considered to be part of the Hospital Quality Control for specimens; therefore, use of this test is not covered and considered provider liability.

COVERAGE Medicare Advantage Plans and Commercial Products Benefits may vary between groups and contracts. Please refer to the appropriate Benefit Booklet, Evidence of Coverage or Subscriber Agreement for applicable laboratory testing medically necessary benefits/coverage.

BACKGROUND Advertised as bringing a new level of diagnostic accuracy and patient safety to the biopsy evaluation process, and reducing the incidence of "Specimen Provenance Complications", the “Know Error®” system is a DNA test used to verify the identity of biopsy specimens. The Know Error® test is thought to prevent misidentification errors in the biopsy evaluation process.

Prior to the biopsy procedure a reference sample of the patient's DNA is taken and sent to an independent forensic lab. A biopsy kit with bar-coded specimen containers is sent to the surgeon who places the specimen in them and returns them to the pathology lab for evaluation. If the biopsy report is positive, the forensic lab compares the biopsy tissue to the reference sample to absolutely confirm the patient's identity. BCBSRI considers this test to be part of the Hospital Quality Control for specimens and use of this test is considered to be provider liability.

CODING Medicare Advantage Plans and Commercial Products Tests should be reported with the unlisted code (84999), following the unlisted process as there are no specific CPT codes.

84999 Unlisted chemistry procedures

RELATED POLICIES Unlisted Procedures

Payment Policy | Specimen Provenance Error Testing

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW.BCBSRI.COM

PUBLISHED Provider Update, December 2023 Provider Update, September 2020 Provider Update, April 2018 Provider Update, May 2017 Provider Update, March 2012

REFERENCES None

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This medical policy is made available to you for informational purposes only. It is not a guarantee of payment or a substitute for your medical judgment in the treatment of your patients. Benefits and eligibility are determined by the member's subscriber agreement or member certificate and/or the employer agreement, and those documents will supersede the provisions of this medical policy. For information on member-specific benefits, call the provider call center. If you provide services to a member which are determined to not be medically necessary (or in some cases medically necessary services which are non-covered benefits), you may not charge the member for the services unless you have informed the member and they have agreed in writing in advance to continue with the treatment at their own expense. Please refer to your participation agreement(s) for the applicable provisions. This policy is current at the time of publication; however, medical practices, technology, and knowledge are constantly changing. BCBSRI reserves the right to review and revise this policy for any reason and at any time, with or without notice. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. CLICK THE ENVELOPE ICON BELOW TO SUBMIT COMMENTS