Medical Policy Revision: Angiogenic Inhibitors for the Treatment of Ophthalmic Macular Conditions
Effective April 13, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for treatment of ophthalmic macular conditions.
Based on the guidelines of our revised medical policy, Angiogenic Inhibitors for the Treatment of Ophthalmic Macular Conditions, claims for services provided April 13, 2015 and after that are submitted with ICD-9 diagnosis codes 379.31 or V43.1 or ICD-10 diagnosis codes H27.03 or Z96.1 will be processed as follows:
- Claims that include CPT® code 67028 will pend while information to determine medical necessity is requested and reviewed.
- Claim lines that include HCPCS code J7312 will be denied as not medically necessary.
Review this revised policy in our online Medical Policy Manual.
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 13, 2015.
CPT® is a registered mark of the American Medical Association.