Medical Policy Revision: Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
Effective November 1, 2018, 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, which identify when certain procedures are considered medically necessary.
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 November 1, 2018 will be processed as noted below.
- Claims for services provided to patients who are between 15 and 55 years of age that include CPT® codes 27415, 27416, 29866 and/or 29867 will pend, regardless of the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed.
If we determine, following our review, that the services in question do not meet the criteria of our policy, CPT codes 27415, 27416, 29866 and/or 29867 will 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 November 1, 2018.
CPT® is a registered mark of the American Medical Association.