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Medical Policy Revision: Implantable Bone Conduction and Bone-Anchored Hearing Aids

Effective November 7, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Implantable Bone-Conduction and Bone-Anchored Hearing Aids.
 

Access our Medical Policy Manual to review this medical policy content.¹


Based on the submitted diagnosis code(s), claims submitted for services provided on and after November 7, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) and Medicare Advantage (MA) plans will be processed as follows.

  • Information may be requested to help us determine the medical appropriateness of the services represented by CPT® code 69710 or 69711. Following our review of medical record information, these services may be denied as not medically necessary.
  • The services represented by CPT codes 69710 or 69711 may 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 November 7, 2019.

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

¹ The 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.

Published on: August 8, 2019, 15:07 PM ET
Last updated on: August 8, 2019, 02:45 AM ET