Medical Policy Revision: Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid

Effective April 17, 2019, Horizon BCBSNJ will change the way we process claims for certain services/supplies provided to members enrolled in Horizon BCBSNJ Commercial plans based on revisions to our medical policy, Continuous or Intermittent Monitoring of Glucose in the Interstitial Fluid.

Additionally, effective April 17, 2019, we will begin to process claims for services/supplies provided to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) per this policy content.¹

Access our Medical Policy Manual to review this policy content.

Based on the contents of our revised policy, claims for services provided on and after April 17, 2019 will be processed as noted below.

• Medical record information may be requested to help us determine the medical appropriateness of CPT® codes 95249, 95250, 95251 and/or 99091 included on claims for services/supplies provided to patients enrolled in Horizon BCBSNJ MA plans.
  
  Following our review of medical record information, CPT codes 95249, 95250, 95251 and/or 99091 may be denied as services/supplies not related to the submitted diagnosis code(s).

• HCPCS codes A9276, A9277 and/or A9278 submitted on claims for services/supplies provided to patients enrolled in Horizon BCBSNJ MA plans will be denied, regardless of the submitted diagnosis code(s), as not medically necessary.

• Medical record information may be requested to help us determine the medical appropriateness of HCPCS codes K0553 and/or K0554 included on claims for services/supplies provided to patients enrolled in both Horizon BCBSNJ MA plans and Horizon BCBSNJ Commercial plans.
  
  Following our review of medical record information, HCPCS codes K0553 and/or K0554 may be denied as services/supplies not related to the submitted diagnosis code(s).

• CPT codes 0446T, 0447T and/or 0448T submitted on claims for services/supplies provided to patients enrolled in both Horizon BCBSNJ MA plans and Horizon BCBSNJ Commercial plans will be denied, regardless of the submitted diagnosis code(s), as experimental/investigative 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 April 17, 2019.

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

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