Medical Policies pertaining to Transcranial Magnetic Stimulation to be Updated
Effective November 12, 2020, Horizon BCBSNJ will change the way we consider certain claims based on updates to the following medical policies:
- Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders.
- Treatment of Tinnitus
- Navigated Transcranial Magnetic Stimulation (nTMS)
Access our Medical Policy Manual to review the content of these medical policies.¹
Claims submitted for services provided on and after November 12, 2020 to patients enrolled in Horizon BCBSNJ Medicare Advantage plans will be processed as follows.
- Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 90867, 90868 or 90869².
Following our review of medical record information, these services may be denied as “not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.” - Based on the submitted diagnosis code(s), the services represented by CPT® codes 90867, 90868 or 908692 may be denied as “not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.”
Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after November 12, 2020.
¹The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.
²Medical policy, Treatment of Tinnitus, does not include guidelines pertaining to CPT code 90869.
CPT® is a registered mark of the American Medical Association.
