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Medical Policy Revision: Dermatologic Applications of Photodynamic Therapy

Effective March 14, 2019, we will change the way we process claims for certain services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Commercial plans, Administrative Services Only (ASO) plans and Medicare Advantage (MA) plans based on revisions to our medical policy, Dermatologic Applications of Photodynamic Therapy.

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


Claims submitted for services provided on and after March 14, 2019 will be processed as noted below.

  • Medical record information may be requested to help us determine the medical appropriateness of the services represented by CPT® code 96567 and/or HCPCS codes J7308, J7309 included on claims for services provided to patients enrolled in Horizon BCBSNJ Commercial and ASO plans.

    Following our review of medical record information, the services represented by these codes may be denied as experimental/investigational, noncovered services.
     
  • Medical record information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 96573, 96574 and/or HCPCS code J7345 included on claims for services provided to patients enrolled in Horizon BCBSNJ MA plans.

    Following our review of medical record information, the services represented by these codes 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 March 14, 2019.

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 Centers for Medicare & Medicaid Services (CMS) guidelines, National Coverage Determinations (NCDs) and Local Coverage Determinations (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.

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

Published on: December 12, 2018, 13:36 p.m. ET
Last updated on: December 12, 2018, 13:38 p.m. ET