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BCBS Horizon Medical Policy Updates – May 2021
Click here to view the Blue Cross Blue Shield BCBS Horizon Medical Policy Updates »
May 2021 BCBS Horizon Medical Policy Updates:
- Allergy Testing
- Ambulance Services – Horizon Blue Cross Blue Shield of New Jersey
- Ambulatory Electrocardiographic Monitoring – Horizon Blue Cross Blue Shield of New Jersey
- Analysis of MGMT Promoter Methylation in Malignant Gliomas
- Analysis of Proteomic Patterns in Serum to Identify Cancer
- Artificial Intervertebral Disc: Cervical Spine
- Artificial Intervertebral Disc: Lumbar Spine
- ASC Multiple Procedure Methodology – Horizon Blue Cross Blue Shield of New Jersey
- Assistant at Surgery – Horizon Blue Cross Blue Shield of New Jersey
- Axial Lumbosacral Interbody Fusion
- Balloon Sinuplasty – Horizon Blue Cross Blue Shield of New Jersey
- Bariatric Surgery Billed With Hiatal Hernia Repair – Horizon Blue Cross Blue Shield of New Jersey
- Bilateral Procedures – Horizon Blue Cross Blue Shield of New Jersey
- Billing Guidelines for Maternity Services – Horizon Blue Cross Blue Shield of New Jersey
- Bone Morphogenetic Protein
- Burosumab-twza (Crysvita)
- Cardiac Event Detection – Horizon Blue Cross Blue Shield of New Jersey
- Cardiovascular Implant Device Monitoring Services – Horizon Blue Cross Blue Shield of New Jersey
- Claim Editing Policies – Horizon Blue Cross Blue Shield of New Jersey
- ClaimsXten Editing Rules – Horizon Blue Cross Blue Shield of New Jersey
- Clinical Trials Support Program – Horizon Blue Cross Blue Shield of New Jersey
- Cochlear Implantation
- Colonoscopy with Modifier 59 – Horizon Blue Cross Blue Shield of New Jersey
- Conscious Sedation – Horizon Blue Cross Blue Shield of New Jersey
- Consumable Medical Supplies – Horizon Blue Cross Blue Shield of New Jersey
- Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies – Horizon Blue Cross Blue Shield of New Jersey
- Co-Surgeon Reimbursement – Horizon Blue Cross Blue Shield of New Jersey
- Daily Management of Epidural or Subarachnoid Continuous Drug Administration – Horizon Blue Cross Blue Shield of New Jersey
- Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)
- Deep Brain Stimulation
- Diabetic Screening Services – Horizon Blue Cross Blue Shield of New Jersey
- Diabetic Supplies – Horizon Blue Cross Blue Shield of New Jersey
- Distinct Procedural Service Modifiers – Horizon Blue Cross Blue Shield of New Jersey
- Drug and Immunization Pricing – Horizon Blue Cross Blue Shield of New Jersey
- Drug Wastage – Modifier JW – Horizon Blue Cross Blue Shield of New Jersey
- Dry Needling of Myofascial Trigger Points
- Duplex Scanning – Horizon Blue Cross Blue Shield of New Jersey
- Electrical Bone Growth Stimulation of the Appendicular Skeleton
- Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- Electrocardiographic Body Surface Mapping
- Electrotherapies in Pain Management
- Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
- Enhancement to CMS Always Bundled Edit – Horizon Blue Cross Blue Shield of New Jersey
- Eptinezumab-jjmr (Vyepti)
- Eribulin Mesylate (Halaven)
- Erwinaze (Asparaginase Erwinia Chrysanthemi), Oncaspar (pegaspargase) and Asparlas (calaspargase pegol-mknl)
- Erythropoietin Therapy: Epoetin Alfa, Darbepoetin Alfa, Pegylated (PEG)-epoetin Beta, and Epoetin Alfa-epbx
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging – Horizon Blue Cross Blue Shield of New Jersey
- Evaluation and Management Services with Chiropractic Manipulative Treatment – Horizon Blue Cross Blue Shield of New Jersey
- Evaluation and Management Services with Osteopathic Manipulative Treatment – Horizon Blue Cross Blue Shield of New Jersey
- Facet Arthroplasty
- Fulvestrant (Faslodex)
- Genetic Testing for Alzheimer Disease
- Genetic Testing for CADASIL Syndrome
- Genetic Testing for Limb-Girdle Muscular Dystrophies
- Hematopoietic Stem Cell Transplantation for Breast Cancer
- Hip Arthroscopy – Horizon Blue Cross Blue Shield of New Jersey
- Home Oxygen Therapy
- Home Spirometry
- Hot or Cold Pack Therapy – Horizon Blue Cross Blue Shield of New Jersey
- Image-Guided Minimally Invasive Decompression for Spinal Stenosis
- In Vivo Analysis of Colorectal Polyps
- Inpatient Consultations – Horizon Blue Cross Blue Shield of New Jersey
- Insulin Potentiation Therapy
- Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)
- Interspinous Fixation (Fusion) Devices
- Interventions for Progressive Scoliosis
- Intraoperative Neurophysiologic Monitoring
- Isolated Limb Perfusion/Isolated Limb Infusion for Malignant Melanoma
- Knee Arthroscopy – Horizon Blue Cross Blue Shield of New Jersey
- Knee Braces
- Lab Panel Rebundling – Horizon Blue Cross Blue Shield of New Jersey
- Laboratory Tests for Heart and Kidney Transplant Rejection
- Luspatercept-aamt (Reblozyl)
- Manipulation Under Anesthesia
- Maternity Reimbursement – Horizon Blue Cross Blue Shield of New Jersey
- Measurement of Long-Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor
- Medical Nutritional Therapy for Inherited Metabolic Disease
- Melphalan (Alkeran and Evomela)
- Modifier 25 – Horizon Blue Cross Blue Shield of New Jersey
- Modifier 52 – Horizon Blue Cross Blue Shield of New Jersey
- Modifier 53 – Horizon Blue Cross Blue Shield of New Jersey
- Modifier 54 – Horizon Blue Cross Blue Shield of New Jersey
- Modifier 55 – Horizon Blue Cross Blue Shield of New Jersey
- Modifier 56 – Horizon Blue Cross Blue Shield of New Jersey
- 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
- Modifier 78 – Horizon Blue Cross Blue Shield of New Jersey
- Molecular Testing for Variants Associated with Hereditary Ovarian Cancer
- 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
- Nerve Graft with Radical Prostatectomy
- Nivolumab (Opdivo)
- Non Oral Drug Therapy for Pulmonary Hypertension
- Noncovered Related Services – Horizon Blue Cross Blue Shield of New Jersey
- Non-ESRD ESA Level Reporting – Horizon Blue Cross Blue Shield of New Jersey
- Nusinersen (Spinraza)
- Occipital Nerve Stimulation
- Orthopedic Applications of Platelet-Rich Plasma
- Outpatient Consultations – Horizon Blue Cross Blue Shield of New Jersey
- Outpatient Laboratory Claims: Referring Practitioner Required – Horizon Blue Cross Blue Shield of New Jersey
- Outpatient Therapy Daily Maximum – Horizon Blue Cross Blue Shield of New Jersey
- Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty
- Patisiran (Onpattro)
- Pegloticase (Krystexxa)
- Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation
- Physician Extenders Non-Surgical Services – Horizon Blue Cross Blue Shield of New Jersey
- Pre-Admission Testing – Horizon Blue Cross Blue Shield of New Jersey
- Prescription Digital Therapeutics for Substance Abuse
- Pulmonary Diagnostic Procedures when billed with E&M Codes – Horizon Blue Cross Blue Shield of New Jersey
- Radiology, Preliminary and Double Reads – Horizon Blue Cross Blue Shield of New Jersey
- Radiopharmaceuticals – Horizon Blue Cross Blue Shield of New Jersey
- Removal of Impacted Cerumen Requiring Instrumentation – Horizon Blue Cross Blue Shield of New Jersey
- Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
- Sacituzumab govitecan-hziy (Trodelvy)
- Sacral Nerve Neuromodulation/Stimulation
- Screening and Diagnostic Mammography & 3D Tomosynthesis – Horizon Blue Cross Blue Shield of New Jersey
- Sensory Integration Therapy and Auditory Integration Therapy
- Serum Holotranscobalamin as a Marker of Vitamin B12 (Cobalamin) Status
- Smoking Cessation – BCBS Horizon Blue Cross Blue Shield of New Jersey
- Speech Generating Devices
- Status N Codes – Horizon Blue Cross Blue Shield of New Jersey
- Subtalar Arthroereisis
- Telemedicine Services – BCBS Horizon Blue Cross Blue Shield of New Jersey
- Tisagenlecleucel (Kymriah)
- Tocilizumab (Actemra)
- Ulcer Debridement and Ulcer Stages – BCBS Horizon Blue Cross Blue Shield of New Jersey
- Urine Drug Screening/Testing – Horizon Blue Cross Blue Shield of New Jersey
- Vascular Endothelial Growth Factor Inhibitor and Human Epidermal Growth Factor Receptor Inhibitor
- Vertebral Axial Decompression
- Vertical Expandable Prosthetic Titanium Rib
Click here to view the Blue Cross Blue Shield BCBS Horizon Medical Policy Updates »
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