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Medical Policy Revision: Cosmetic Procedures

Effective March 16, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for certain cosmetic procedures.

Based on the guidelines of our revised medical policy, Cosmetic Procedures, the procedure codes listed below included on claims for service dated March 16, 2015 and after will be denied as ineligible cosmetic procedures regardless of the submitted diagnosis.

CPT® (Current Procedural Terminology) codes
11950, 11951, 11952, 11954, 11960, 11970, 11971, 15775, 15776, +15777, 15786, +15787, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, 15835, 15836, 15837, 15876, 15877, 15879, 21282, 36469, 67916 and 67923

CDT (Current Dental Terminology) codes
D9975

HCPCS (Healthcare Common Procedure Coding System) codes
G0429, Q2026 and Q2028

Review this revised policy in our online Medical Policy Manual.

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 March 16, 2015.

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

Published on: December 16, 2014, 12:00 p.m. ET
Last updated on: November 24, 2020, 23:24 p.m. ET