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Medical Policy Revision: Extracorporeal Photopheresis

Effective January 27, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for certain services related to extracorporeal photopheresis.

Based on the guidelines of our revised medical policy, Extracorporeal Photopheresis, on and after a service date of January 27, 2015, claims submitted with CPT® code 36522 with any of the diagnosis codes listed below will pend while information required to determine medical necessity is requested and reviewed.

ICD-9 diagnosis codes:
279.51, 279.52, 996.83, 996.85

ICD-10 diagnosis codes:
D89.810, D89.811, T86.00, T86.01, T86.02, T86.03, T86.09, T86.20, T86.21, T86.22, T86.290, T86.298, T86.30, T86.31, T86.32, T86.39

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 January 27, 2015.

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

Published on: October 29, 2014, 14:00 p.m. ET
Last updated on: November 24, 2020, 23:09 p.m. ET