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Medical Policy Revision: Bio-Engineered Skin and Soft Tissue Substitutes

Effective October 1, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for the use of bio-engineered skin and soft tissue substitutes.

The guidelines of our revised medical policy, Bio-Engineered Skin and Soft Tissue Substitutes, identifies situations in which the use of bio-engineered skin and soft tissue substitutes would be considered medically necessary or investigational. This policy also identifies types of skin and soft tissue substitutes to be considered as investigational.

The guidelines of this policy DO NOT apply to members enrolled in Horizon BCBSNJ Medicare Advantage plans.

Review this revised policy in our Medical Policy Manual.

Based on the guidelines of this revised policy, claims submitted for services provided on and after October 1, 2016 that include HCPCS surgical supply codes Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4117, Q4118, Q4119, Q4120, Q4121, Q4123, Q4125, Q4126, Q4127, Q4129, Q4130, Q4134, Q4135, Q4136, Q4137, Q4138, Q4139, Q4140, Q4141, Q4142, Q4143, Q4146, Q4147, Q4148, Q4149, Q4150, Q4151, Q4152, Q4153, Q4155, Q4156, Q4157, Q4158, Q4159, Q4160, Q4161, Q4164 and Q4165 will pend while information is requested/reviewed to help us determine if the service in question is considered medically necessary or investigational.

Following our review, those HCPCS surgical supply codes noted above that do not meet the criteria of our revised policy will be denied as investigational services/supplies.

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 1, 2016.

Published on: June 30, 2016, 08:00 a.m. ET
Last updated on: November 25, 2020, 00:26 a.m. ET