Medical Policy Implementation: Amniotic Membrane and Amniotic Fluid Injections

Effective October 26, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for the injections of micronized amniotic membrane or amniotic fluid.

Based on the guidelines of our revised medical policy, Amniotic Membrane and Amniotic Fluid Injections, HCPCS codes Q4139 and Q4155 submitted on claims for services provided on and after October 26, 2015 will be denied as investigational services.

Review this revised policy in our online Medical Policy Manual.

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 October 26, 2015.