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

Effective February 1, 2019, claims for certain services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans will also be processed per our medical policy, Bio-Engineered Skin and Soft Tissue Substitutes. (This policy currently only applies to patients enrolled in Horizon BCBSNJ Commercial plans and Administrative Services Only (ASO) plans).

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after February 1, 2019 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

• Medical record information may be requested to help us determine the medical appropriateness of the injectables or skin substitutes represented by the submission of HCPCS codes Q4112, Q4113, Q4125, Q4130, Q4141, Q4142 and/or Q4143 on claims
  
  Following our review of medical record information, the codes above may be denied as experimental/investigational, noncovered 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 on and after February 1, 2019.

¹ The content of Horizon BCBSNJ medical policies that apply to services provided to Horizon BCBSNJ MA members may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). Horizon BCBSNJ follows Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and LCDs in our processing of claims for services provided to Horizon BCBSNJ MA members. For those services where no LCD or NCD exists, claims for services provided to MA members will be processed based on our policy guidelines.