April 12, 2021

Effective July 1, 2021 BlueCross BlueShield of South Carolina and BlueChoice^® HealthPlan will implement a new medical policy addressing fibromyalgia testing. The policy, CAM 272 – Fibromyalgia Testing, will be added to the Medical Policies page, which can be accessed through www.SouthCarolinaBlues.com and www.BlueChoiceSC.com.

Fibromyalgia (FM) is a chronic, diffuse pain condition and the most common cause of chronic widespread musculoskeletal pain. It is also known by "diffuse myofascial pain syndrome", "fibromyalgia­ fibromyositis syndrome", or "fibromyalgia syndrome". Although of generally unknown etiology and pathophysiology, it can be found with "fatigue, cognitive disturbance psychiatric symptoms, and multiple somatic symptoms"; however, presentation may vary from patient to patient. Controversy has arisen regarding the disease origin, as it has been considered to be psychogenic or psychosomatic, but recent research indicates it as a disorder of pain regulation, a form of "central sensitization".

A portion of the policy reads:

1. Genetic testing to aid in the diagnosis of fibromyalgia or chronic pain syndromes is consider NOT MEDICALLY NECESSARY. Genetic testing includes, but is not limited to, mutation analysis, copy number variants, epigenetic analysis. mRNA expression. and miRNA expression.
2. Biomarker panel testing with proprietary algorithms and/or index scores for the diagnosis of fibromyalgia (e.g. FM/a®) or chronic pain syndromes (e.g. NutrEval FMV^®) is consider NOT MEDICALLY NECESSARY for all applications.

You may contact us by using the Provider Education Contact Request form with any questions that you have on this bulletin.

BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association.