Medical Policy Implementation: Placement of Iliac Vein Stent

Effective July 24, 2019, Horizon BCBSNJ will change the way we consider certain professional and facility claims based on the implementation of our medical policy Placement of Iliac Vein Stent.

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

Claims submitted for services provided on and after July 24, 2019 to patients enrolled in Horizon BCBSNJ Administrative Services Only (ASO) plans will be processed as follows.

• 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 37238 or 37239. Following our review of medical record information, 37238 or 37239 may be denied as experimental/investigational, noncovered services.
• Based on the submitted diagnosis code(s), the services represented by CPT codes 37238 or 37239 may be denied as experimental/investigational, noncovered 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 July 24, 2019.

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

¹This policy content does not apply to claims for services provided to members enrolled in Horizon BCBSNJ fully insured commercial plans/products. As part of our Surgical and Implantable Device Management Program for Cardiac Services program, TurningPoint Healthcare Solutions, LLC (TurningPoint) manages and maintains the medical policy criteria and guidelines that will apply on and after July 15, 2019 to members enrolled in fully insured Horizon BCBSNJ commercial plans/products as part of this program.

The 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.