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Medical Policy Implementation: Laminectomy

Effective July 22, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider laminectomy claims.

Based on the guidelines of our medical policy, Laminectomy, claims submitted for services provided on and after July 22, 2015 that include CPT® codes 63001, 63005, 63015, 63017, 63270, 63272, 63275, 63277, 63280, 63282, 63285 or 63287 and one or more of the diagnosis codes listed below will pend while information required to determine medical appropriateness is requested and reviewed:

ICD-9 diagnosis codes: 192.2, 192.3, 198.3, 199.0, 225.3, 225.4, 237.5, 237.6, 239.7, 324.1, 344.60, 349.2, 353.1, 355.0, 715.98, 719.48, 720.0, 720.2, 721.0, 721.1, 721.2, 721.3, 721.41, 721.42, 722.0, 722.10, 722.52, 722.71, 722.73, 722.83, 722.91, 722.93, 723.0, 723.1, 723.4, 723.7, 724.01, 724.02, 724.03, 724.09, 724.1, 724.2, 724.3, 724.4, 724.5, 724.9, 728.5, 729.2, 729.4, 738.2, 738.4, 756.10, 756.11, 756.12, 953.0, 953.1, 953.2, 953.5

ICD-10 diagnosis codes: C72.0, C72.1, C70.1, C79.31, C79.49, C80.0, D33.4, D32.1, D43.0, D43.1, D43.2, D43.4, D42.0, D42.1, D42.9, D49.7, G06.1, G83.4, G96.12, G96.19, G54.1, G57.00, G57.01, G57.02, M19.90, M25.50, M08.1, M45.0, M45.1, M45.2, M45.3, M45.4, M45.5, M45.6, M45.7, M45.9, M48.8X1, M48.8X2, M48.8X3, M48.8X4, M48.8X5, M48.8X6, M48.8X7, M48.8X9, M46.1, M47.21, M47.22, M47.23, M47.811, M47.812, M47.813, M47.891, M47.892, M47.893, M47.011, M47.012, M47.013, M47.014, M47.015, M47.016, M47.019, M47.021, M47.022, M47.029, M47.11, M47.12, M47.13, M47.24, M47.25, M47.814, M47.815, M47.894, M47.895, M47.26, M47.27, M47.28, M47.816, M47.817, M47.818, M47.896, M47.897, M47.898, M47.14, M47.15, M47.16, M50.20, M50.21, M50.22, M50.23, M51.26, M51.27, M51.36, M51.37, M50.00, M50.01, M50.02, M50.03, M51.06, M96.1, M46.41, M46.42, M46.43, M50.10, M50.11, M50.12, M50.13, M50.80, M50.81, M50.82, M50.83, M50.90, M50.91, M50.92, M50.93, M46.46, M46.47, M51.86, M51.87, M48.01, M48.02, M48.03, M99.20, M99.21, M99.30, M99.31, M99.40, M99.41, M99.50, M99.51, M99.60, M99.61, M99.70, M99.71, M54.2, M54.11, M54.12, M54.13, M67.88, M48.04, M48.05, M99.22, M99.32, M99.42, M99.52, M99.62, M99.72, M48.06, M48.07, M99.23, M99.33, M99.43, M99.53, M99.63, M99.73, M48.00, M54.6, M54.5, M54.30, M54.31, M54.32, M54.40, M54.41, M54.42, M51.14, M51.15, M51.16, M51.17, M54.14, M54.15, M54.16, M54.17, M54.89, M54.9, M43.20, M43.21, M43.22, M43.23, M43.24, M43.25, M43.26, M43.27, M43.8X9, M53.80, M53.84, M53.85, M53.9, M35.7, M54.10, M79.2, M72.9, M95.3, M99.81, M43.00, M43.01, M43.02, M43.03, M43.04, M43.05, M43.06, M43.07, M43.09, M43.10, M43.11, M43.12, M43.13, M43.14, M43.15, M43.16, M43.17, M43.19, Q76.49, Q76.2, S14.2xxA, S24.2xxA, S34.21xA, S34.4xxA

CPT codes 63001, 63005, 63015, 63017, 63270, 63272, 63275, 63277, 63280, 63282, 63285 or 63287 included on claims for services provided on and after July 22, 2015; that include a diagnosis code other than one the codes listed above 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 with dates of service on and after July 22, 2015.

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

Published on: April 22, 2015, 10:00 a.m. ET
Last updated on: November 24, 2020, 23:36 p.m. ET