Medical Policy Revision: Gait Trainers and Standing Frames

Effective August 16, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for standing devices and gait trainers.

We encourage you to review the guidelines of our revised medical policy, Gait Trainers and Standing Frames, in our Medical Policy Manual which identify when the use of standing devices and gait trainers are considered medically necessary.

Based on the guidelines of our revised medical policy, Gait Trainers and Standing Frames, claims for services/supplies provided on and after August 16, 2018 will be processed as noted below.

• HCPCS codes E8000, E8001 and/or E8002 submitted on claims for supplies provided to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be denied, regardless of the submitted diagnosis code(s), as experimental/investigational, non-covered services.
   
• Claims that include HCPCS codes E8000, E8001, E8002 and/or E0638 submitted for supplies provided to members enrolled in plans other than Horizon BCBSNJ MA plans may, based on the submitted diagnosis code(s), pend while information required for us to determine medical appropriateness 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 on and after August 16, 2018.

As part of the Horizon Care@Home program, CareCentrix conducts review of requests for Durable Medical Equipment (including Medical Foods [Enteral], and Diabetic and Other Medical Supplies); Orthotics and Prosthetics and Home Infusion Therapy Services, including hemophilia.