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Medical Policy Implementation: Orthognathic Surgery

Effective May 1, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Orthognathic Surgery.

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


Claims submitted for services provided on and after May 1, 2019 to patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only (ASO) plans will be processed as noted below.

  • Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 21085, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21230, 21244, 21245, 21246 or 21247.
  • Following our review, these services may be denied as not medically necessary or experimental/investigative, non-covered services.

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 on and after May 1, 2019.

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

¹ The guidelines of our Orthognathic Surgery medical policy do not apply to claims for services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.

Published on: January 30, 2019, 15:22 p.m. ET
Last updated on: January 31, 2019, 01:12 a.m. ET