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Announcement Update: Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid

The information below corrects an announcement originally posted on January 17, 2019. The policy changes announced apply ONLY to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.


Effective April 17, 2019, Horizon BCBSNJ will change the way we process claims for certain services/supplies provided to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) based on our medical policy, Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid.¹

Access our Medical Policy Manual to review this policy content.

Claims for services provided on and after April 17, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as noted below.

  • Based on the submitted diagnosis code(s), medical record information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 95249, 95250, 95251, 99091 and HCPCS codes K0553, K0554. Following our review of medical record information, the codes above may be denied as services/supplies not related to the submitted diagnosis code(s).
     
  • Regardless of the submitted diagnosis code(s), the services represented by HCPCS codes A9276, A9277 or A9278 will be denied as not medically necessary.
     
  • Regardless of the submitted diagnosis code(s), the services represented by CPT codes 0446T, 0447T or 0448T will be denied as experimental/investigative, noncovered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after April 17, 2019.

CPT® is a registered mark of the American Medical Association.

¹ Horizon BCBSNJ medical policies that apply to claims for services provided to Horizon BCBSNJ MA members include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). Horizon BCBSNJ follows NCD, LCD and Centers for Medicare & Medicaid Services (CMS) guidelines when processing claims for Horizon BCBSNJ MA members. For procedures/services where no LCD or NCD exists, claims for services provided to MA members will be processed based on our policy guidelines.

Published on: April 22, 2019, 03:00 a.m. ET
Last updated on: April 22, 2019, 09:54 a.m. ET