Medical Policy Revision: Electrical Bone Growth Stimulation of the Appendicular Skeleton

Effective April 16, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain professional claims based on the guidelines of our revised medical policy, Electrical Bone Growth Stimulation of the Appendicular Skeleton*.

We encourage you to visit our Medical Policy Manual to review the guidelines of our Electrical Bone Growth Stimulation of the Appendicular Skeleton medical policy which identify when services and supplies related to electrical bone growth stimulation are considered medically necessary.

Based on the guidelines of our medical policy, Electrical Bone Growth Stimulation of the Appendicular Skeleton, claims for services provided on and after April 16, 2018 plans will be processed as noted below.

• Claims for services provided to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans that include CPT^® code 20975 and/or HCPCS codes E0747, E0748, E0749 will pend, regardless of the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed.
  
  Services that do not meet the criteria outlined in our policy will be denied as not medically necessary.

• HCPCS code E0747 submitted on claims for members enrolled in Horizon BCBSNJ plans other than MA plans will be denied as an experimental/investigational non-covered service regardless of the submitted diagnosis code(s).

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 April 16, 2018.

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

*formerly titled Electrical Bone Growth Stimulation