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Medical Policy Implementation: Axial Lumbosacral Interbody Fusion

Effective November 15, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for spinal fusion.

Our medical policy, Axial Lumbosacral Interbody Fusion, identifies when percutaneous pre-sacral access to the L4 - S1 vertebra for spinal fusion is considered medically necessary and when it would be considered investigational.

We encourage you to review this policy in our Medical Policy Manual.

Based on the guidelines of our medical policy, Axial Lumbosacral Interbody Fusion, claims for services provided on and after November 15, 2017 that include CPT® codes 22586 will pend, regardless of the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed.

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 November 15, 2017.

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

Published on: August 15, 2017, 11:15 a.m. ET
Last updated on: November 25, 2020, 00:46 a.m. ET