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Medical Policy Implementation: Intraoperative Neurophysiologic Monitoring

Effective May 7, 2020, Horizon BCBSNJ will change the way we consider certain professional claims based on the implementation of our medical policy, Intraoperative Neurophysiologic Monitoring.

Access our Medical Policy Manual to review this medical policy content.¹

Based on this policy implementation, claims submitted for services provided on and after May 7, 2020 to patients enrolled in Horizon BCBSNJ commercial and Administrative Services Only (ASO) plans will be processed as follows.

  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT® codes 92585, 95865, 95907, 95908, 95909, 95910, 95911, 95925, 95926, 95928, 95929, +95940, +95941 or HCPCS code G0453.

    Following our review of medical record information, these services may be denied as not medically necessary or as experimental/investigational non-covered services.

Based on this policy implementation, claims submitted for services provided on and after May 7, 2020 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT codes 95829 or 95955.

    Following our review of medical record information, these services may be denied as not medically necessary or as experimental/investigational non-covered services.

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 May 7, 2020.

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

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.

Published on: February 6, 2020, 01:46 a.m. ET
Last updated on: February 6, 2020, 13:19 p.m. ET