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Medical Policy Revision: Electrotherapies in Pain Management

Effective July 22, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for electrotherapies used for pain management.

Based on the guidelines of our revised medical policy, Electrotherapies in Pain Management:

  • CPT® code 64550 or HCPCS codes E0720, E0730, E0731 or E0745 submitted on claims for services provided on and after July 22, 2015, will be denied as experimental/investigational services when one of the ICD-9/ICD-10 diagnosis codes listed below is included on the claim in question.

ICD-9 diagnosis codes: 338.12, 338.18, 346.00, 346.01, 346.02, 346.03, 346.11, 346.13, 346.21, 346.23, 346.31, 346.33, 346.41, 346.43, 346.51, 346.53, 346.61, 346.63, 346.71, 346.73, 346.81, 346.83, 346.91, 346.93, 339, 784.0.

ICD-10 diagnosis codes: G89.12, G89.18, G43.109, G43.119, G43.101, G43.111, G43.019, G43.011, G43.819, G43.A1, G43.B1, G43.C1, G43.D1, G43.811, G43.419, G43.411, G43.839, G43.831, G43.519, G43.511, G43.619, G43.611, G43.719, G43.711, G43.819, G43.811, G43.919, G43.911, G44.1, R51

  • CPT codes 0278T, 0282T, 0283T, 0284T or 0285T submitted on claims for services provided on and after July 22, 2015, will be denied as experimental/investigational services regardless of the diagnosis code(s) included on the claim in question.

Review this revised policy in our 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 July 22, 2015.

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

Published on: April 22, 2015, 10:00 a.m. ET
Last updated on: November 24, 2020, 23:36 p.m. ET