Medical Policy Revision: Focal Treatments for Prostate Cancer
Effective January 21, 2020, Horizon BCBSNJ will change the way we consider certain professional and facility claims based on the implementation of our medical policy Focal Treatments for Prostate Cancer.
Access our Medical Policy Manual to review this medical policy content.¹
Based on this policy, professional claims submitted for services provided on and after January 21, 2020 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) and Medicare Advantage (MA) plans will be processed as noted below.
- Regardless of the submitted diagnosis code(s), services represented by CPT® code 53854 will be denied as experimental/investigational, non-covered services.
Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after January 21, 2020.
CPT® is a registered mark of the American Medical Association.
¹The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.