Figure 4.

Payor rules by CPT codes of selected molecular-genetic tests. The heatmap shows rules of 12 selected regional payors (rows) by selected molecular-genetic CPT code (columns). Each cell is colored assuming that the patients' main diagnosis (International Classification of Diseases code) matches the payors policy-specific rules; when multiple different policies exist for different plans (eg, bronze versus platinum-type plans) cells are colored in gray. The newly introduced exome and genome code sets show variability among payors (vertical comparison). Line-wise comparison allows comparison of payors. The matrix (ie, policy rules) changes on a regular basis (blue inset on right for exome/genome code sets) and the overall heterogeneity emphasizes the importance of patient- and policy-tailored claim evidence reasoning (Results) and the need for a flexible workflow that is adaptable to a wide array of other test types. CPT, Current Procedural Terminology.