Click here to view the Humana Medical Policy Updates Updates » September 2024 Humana Medical…
BCBS Horizon Medical Policy Updates – June 2021
Click here to view the Blue Cross Blue Shield BCBS Horizon Medical Policy Updates »
June 2021 BCBS Horizon Medical Policy Updates:
- Alkylating Agent(s) [Temozolomide intravenous (Temodar)]
- Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
- Analysis of Proteomic Patterns in Serum to Identify Cancer
- Anesthesia Care During Interventional Pain Management Procedures
- Arsenic Trioxide (Trisenox)
- Arthroscopy for Treatment of Knee Derangement
- Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer
- Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
- Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
- Axicabtagene Ciloleucel (Yescarta)
- Baroreflex Stimulation Devices
- Belatacept (Nulojix)
- Blinatumomab (Blincyto)
- Brexanolone (Zulresso)
- B-Type Natriuretic Peptide in Heart Failure
- Cabazitaxel (Jevtana)
- Capsaicin 8% patch (Qutenza)
- Cardiac Event Detection – Horizon Blue Cross Blue Shield of New Jersey
- Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
- Cardiovascular Implant Device Monitoring Services – Horizon Blue Cross Blue Shield of New Jersey
- Circulating Tumor DNA for Management of Non-Small-Cell-Lung Cancer (Liquid Biopsy)
- Clinical Trials Support Program – Horizon Blue Cross Blue Shield of New Jersey
- Clolar (Clofarabine)
- Closure Devices for Patent Foramen Ovale and Atrial Septal Defects
- Computer-Assisted Navigation for Orthopedic Procedure
- Conscious Sedation – Horizon Blue Cross Blue Shield of New Jersey
- Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid
- Coronary Computed Tomography Angiography With Selective Noninvasive Fractional Flow Reserve
- Crizanlizumab-tmca (Adakveo)
- Cupping Therapy
- Daily Maximum Units for Surgical Pathology and Microscopic Examination – Horizon Blue Cross Blue Shield of New Jersey
- Daratumumab (Darzalex), Daratumumab and hyaluronidase-fihj (Darzalex Faspro)
- Diabetic Screening Services – Horizon Blue Cross Blue Shield of New Jersey
- Discography
- DME Rent to Purchase – Horizon Blue Cross Blue Shield of New Jersey
- Drug Wastage – Modifier JW – Horizon Blue Cross Blue Shield of New Jersey
- Duplicate Claim Logic for Independent Laboratory Services – Horizon Blue Cross Blue Shield of New Jersey
- Electronic Salivary Reflex Stimulator
- Endovascular Therapies for Extracranial Vertebral Artery Disease
- Enfortumab vedotin-ejfv (Padcev)
- Enhanced External Counterpulsation (EECP)
- Epidural Steroid Injections
- Epidurography, Radiological Supervision and Interpretation
- Erythropoietin Therapy: Epoetin Alfa, Darbepoetin Alfa, Pegylated (PEG)-epoetin Beta, and Epoetin Alfa-epbx
- Esophageal pH Monitoring
- Etelcalcetide (Parsabiv)
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging – Horizon Blue Cross Blue Shield of New Jersey
- Explantation of Breast Implants
- Extracorporeal Membrane Oxygenation for Adult Conditions
- Extracranial Carotid Artery Stenting
- Facet Joint Injections/Medial Branch Blocks
- Frequency of Care Coordination Services and ESRD Procedures – Horizon Blue Cross Blue Shield of New Jersey
- Frequency of G0179 – Horizon Blue Cross Blue Shield of New Jersey
- Fulvestrant (Faslodex)
- Gazyva (Obinutuzumab)
- Gemcitabine in sodium chloride injection (Infugem)
- Gene Expression Profiling for Cutaneous Melanoma
- Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
- Genetic Testing for Hereditary Hearing Loss
- Genetic Testing for Hereditary Hemochromatosis
- Genetic Testing for Inherited Thrombophilia
- Genetic Testing for Lactase Insufficiency
- Genetic Testing for Rett Syndrome
- Givosiran (Givlaari)
- Gonadotropin-Releasing Hormone (GnRH) Receptor Antagonist [Degarelix (Firmagon)]
- Gonadotropin-Releasing Hormone Analogs
- Granulocyte Colony Stimulating Factor (G-CSF – Neupogen, Neulasta, Granix, Zarxio, Fulphila, Nivestym, Udenyca, Ziextenzo, Nyvepria) and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF – Leukine)
- Greater Occipital Nerve Block
- H.P. Acthar Gel
- Hematopoietic Cell Transplantation for Hodgkin Lymphoma
- Hip Resurfacing
- Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax), Romidepsin (liquid)]
- Imlygic (Talimogene Laherparepvec)
- Immune Globulin Subcutaneous (Hizentra, Gammagard Liquid, Gamunex-C/Gammaked, HyQvia, Cuvitru, Cutaquig, and Xembify for Subcutaneous Administration)
- Implantable Cardioverter Defibrillator (ICD)
- Implantable Intrathecal Drug Delivery Systems
- Inhaled Nitric Oxide
- Intradialytic Parenteral Nutrition
- Intravenous Antibiotic Therapy for Lyme Disease
- Intravenous Drug Therapy for Multiple Sclerosis
- Isatuximab-irfc (Sarclisa)
- Ixabepilone (Ixempra)
- Laboratory Services Billed by Physicians – Horizon Blue Cross Blue Shield of New Jersey
- Leadless Cardiac Pacemaker
- Liposomal Formulation of Daunorubicin and Cytarabine (Vyxeos)
- Marqibo (Vincristine Sulfate Liposome Injection)
- Melanoma Vaccines
- Meniscal Allografts and Other Meniscal Implants
- Microwave Thermotherapy for Primary Breast Cancer
- Modifier 57 – Horizon Blue Cross Blue Shield of New Jersey
- Modifier 76 – Horizon Blue Cross Blue Shield of New Jersey
- Modifier 77 – Horizon Blue Cross Blue Shield of New Jersey
- Molecular Testing in the Management of Pulmonary Nodules
- Moxetumomab Pasudotox-tdfk (Lumoxiti)
- Mozobil (Plerixafor Injection)
- Multiple Procedure Payment Reduction (MPPR) for Endoscopies – Horizon Blue Cross Blue Shield of New Jersey
- Mutually and Non-Mutually Exclusive NCCI Supplemental Edits – Horizon Blue Cross Blue Shield of New Jersey
- Non-ESRD ESA Level Reporting – Horizon Blue Cross Blue Shield of New Jersey
- Observation Care
- Occupational Therapy in the Home and Outpatient Setting
- Ofatumumab (Arzerra)
- Omacetaxine Mepesuccinate (Synribo)
- Omalizumab (Xolair)
- Onivyde (Irinotecan Liposome Injection)
- Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)
- Orphan Drugs
- Outpatient Laboratory Claims: Referring Practitioner Required – Horizon Blue Cross Blue Shield of New Jersey
- Oxaliplatin (Eloxatin)
- Paclitaxel Protein-Bound Particles (Abraxane)
- Patisiran (Onpattro)
- Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty
- Percutaneous Neurolysis for Trigeminal Neuralgia
- Pharmacogenetic Testing for Pain Management
- Physician Extenders Non-Surgical Services – Horizon Blue Cross Blue Shield of New Jersey
- Placement of Iliac Vein Stent
- Pralatrexate (Folotyn)
- Pre-Admission Testing – Horizon Blue Cross Blue Shield of New Jersey
- Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia
- Pulmonary Diagnostic Procedures when billed with E&M Codes – Horizon Blue Cross Blue Shield of New Jersey
- Radiofrequency Joint Ablation/Denervation
- Recombinant Interleukin-2 (IL-2)
- Reduction Mammaplasty
- Regional Sympathetic Blocks
- Romiplostim (Nplate)
- Sacroiliac Joint Injections
- Sebelipase alfa (Kanuma)
- Serum Holotranscobalamin as a Marker of Vitamin B12 (Cobalamin) Status
- Sipuleucel-T (Provenge)
- Smoking Cessation – Horizon Blue Cross Blue Shield of New Jersey
- Spinal Cord and Implantable Peripheral Nerve Stimulators
- Strontium-89 Chloride (Metastron)
- Teprotumumab-trbw (Tepezza)
- Tocilizumab (Actemra)
- Topotecan Hydrochloride (Hycamtin) Injection
- Total Ankle Replacement (Arthroplasty)
- Transurethral Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia
- Triamcinolone Acetonide Extended-Release (Zilretta)
- Trigger Point Injections
- Ulcer Debridement and Ulcer Stages – Horizon Blue Cross Blue Shield of New Jersey
- Ultrafiltration in Decompensated Heart Failure
- Voretigene neparvovec-rzyl (Luxturna)
- Wearable Cardioverter-Defibrillators
- Xiaflex (Collagenase Clostridium Histolyticum)
- Yondelis (Trabectedin)
Click here to view the Blue Cross Blue Shield BCBS Horizon Medical Policy Updates »
Policy Alerts monitors Commercial and Medicare medical policies for changes. While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. When reviews occur out of cycle they often go unnoticed. Policy Alerts keeps you updated when Payers make coverage changes to medical policies affecting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on medical Insurance decisions in real-time. When changes occur, instant email alerts are delivered to your inbox. Clients have access to detailed coverage reports and medical policies through the interactive Policy Alerts Dashboard portal. Save time each month and keep focused on important Payer medical policy reviews and coverage decisions affecting your business!
Policy Alerts takes a client-focused hands-on approach and is constantly working to provide our customers with helpful insights and actionable analytics. We understand what our clients need and are dedicated to providing timely, accurate, and always up-to-date reports.
Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.
BCBS Horizon
BCBS Horizon
Related Posts
