Medical Policy Implementation: Synthetic Cartilage Implants for Joint Pain

Effective June 10, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on our implementation of a new medical policy, Synthetic Cartilage Implants for Joint Pain.

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

Claims submitted for services provided on and after June 10, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as noted below.

• Regardless of the submitted diagnosis code(s), CPT® code 28291 or HCPCS code L8641 will be denied as an experimental or investigational, non-covered service.

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 June 10, 2019.

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

¹ 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.