Medical Policy Revision: Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions

Effective January 7, 2019, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain professional claims for the treatment of focal articular cartilage lesions.

We encourage you to visit our Medical Policy Manual to review the guidelines of our medical policy, Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions.

Based on the guidelines of our revised medical policy, Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions, claims for services provided on and after January 7, 2019 will be processed as noted below.

• Medical record information may be requested to help us determine the medical appropriateness of CPT® codes 27415, 27416, 29866 and/or 29867 included on claims for services provided to patients who are between 15 and 55 years of age.
  
  Following our review of medical record information, CPT codes 27415, 27416, 29866 and/or 29867 may be denied as experimental/investigational services.

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 January 7, 2019.

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