Medical Policy Implementation: Leadless Cardiac Pacemaker
Effective August 7, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for the implantation of self-contained, percutaneously implanted pacemakers.
Our medical policy, Leadless Cardiac Pacemaker, identifies when implantable leadless pacemakers are considered medically necessary and when they would be considered investigational.
We encourage you to review this policy in our Medical Policy Manual.
Based on the guidelines of our medical policy, Leadless Cardiac Pacemaker:
- CPT® codes 0387T, 0388T, 0389T, 0390T and/or 0391T included on claims for services provided on and after August 7, 2017 to patients enrolled in any Horizon BCBSNJ plan except Horizon BCBSNJ Medicare Advantage plans will be denied as investigational and non-covered services regardless of the submitted diagnosis code(s).
- Claims for services provided on and after August 7, 2017 to patients enrolled in Horizon BCBSNJ Medicare Advantage plans that include CPT® codes 0387T, 0388T, 0389T, 0390T and/or 0391T will pend while information required to determine medical appropriateness is requested and reviewed regardless of the submitted diagnosis code(s).
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 August 7, 2017.
CPT® is a registered mark of the American Medical Association.