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Medical Policy Implementation: Probuphine (Buprenorphine) Implant for Subdermal Administration

Effective April 10, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for the use of Probuphine® for the treatment of opioid dependence.

Our medical policy, Probuphine (Buprenorphine) Implant for Subdermal Administration, identifies when the use of Probuphine would be considered medically necessary or investigational.

We encourage you to review this policy in our Medical Policy Manual.


Based on the guidelines of our medical policy, Probuphine (Buprenorphine) Implant for Subdermal Administration:

  • Claims that include HCPCS code J0570 for services provided on and after April 10, 2017, regardless of submitted diagnosis code(s), will pend while we request information to help us determine if the use of this drug is to be considered medically necessary or investigational.
  • Claims that include CPT® code 11981 for services provided on and after April 10, 2017 may pend, based on the diagnosis code(s) submitted, while we request information to help us determine if the use of this drug is to be considered medically necessary or investigational.

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 April 10, 2017.

Probuphine® is a registered trademark of Titan Pharmaceuticals, Inc.

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

Published on: January 9, 2017, 16:14 p.m. ET
Last updated on: April 27, 2021, 22:48 p.m. ET