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Medical Policy Revision: Botulinum Toxin

Effective December 10, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Botulinum Toxin.

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


Based on the submitted diagnosis code(s), claims submitted for services provided on and after December 10, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as follows.

  • Information may be requested to help us determine the medical appropriateness of the services represented by CPT code 31573. Following our review of medical record information, these services may be denied as cosmetic or experimental/investigational non-covered services.

  • The services represented by CPT® code 31573 may be denied as cosmetic services or as experimental/investigational, non-covered services.

  • The services represented by CPT® codes 31513, 31570, 31571, 46505, 64612, 64615, 64616, 64617, 64640, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 67345, +95873, +95874 may be denied as experimental/investigational, non-covered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after December 10, 2019.

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

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

Published on: September 9, 2019, 03:22 AM ET
Last updated on: September 4, 2019, 05:17 AM ET