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

Effective June 14, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Bio-Engineered Skin and Soft Tissue Substitutes.

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

Claims submitted for services provided on and after June 14, 2019 will be processed as follows:

  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the injectables or skin substitutes represented by the submission of HCPCS codes Q4103 or Q4104 on claims for services provide to patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only plans.

    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 June 14, 2019.

Published on: March 14, 2019, 09:46 a.m. ET
Last updated on: April 27, 2021, 09:58 a.m. ET