Medical Policy Revision: Fecal MicroBiota Transplantation

Effective June 19, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for preparation with instillation of fecal microbiota.

Our medical policy, Fecal MicroBiota Transplantation, identifies circumstances under which fecal microbiota transplantation is considered medically necessary or investigational.

We encourage you to review this policy in our Medical Policy Manual. 

Based on the guidelines of our medical policy, Fecal MicroBiota Transplantation, claims submitted for services provided on and after June 19, 2017 that include CPT® code 44705 and/or HCPCS code G0455 will pend while information to help us determine if the service in question is to be considered medically necessary is requested and reviewed.

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 June 19, 2017.

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