Medical Policy Implementation: Vestibular Function Testing
Effective October 2, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for vestibular tests.
Our medical policy, Vestibular Function Testing, identifies circumstances under which vestibular tests are 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, Vestibular Function Testing, and the submitted diagnosis code(s):
- CPT® codes 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546 and/or 92547 included on claims for services provided on and after October 2, 2017 may be denied for a procedure code/diagnosis code mismatch.
- Claims for services provided on and after October 2, 2017 to patients enrolled in all plans except for Horizon BCBSNJ Medicare Advantage plans that include CPT® codes 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546 and/or 92547 may pend while information to help us determine if the service in question is to be considered medically necessary is requested and reviewed.
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 October 2, 2017.
CPT® is a registered mark of the American Medical Association.