Medical Policy Revision: Implantable Cardioverter Defibrillator (ICD)

Effective March 14, 2019, we will change the way we consider certain claims based on revisions to our medical policy, Implantable Cardioverter Defibrillator (ICD).

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

Claims for services provided on and after March 14, 2019 to patients enrolled in Horizon BCBSNJ Commercial, Administrative Services Only (ASO) and Medicare Advantage (MA) plans will be processed as noted below.

• Medical record information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 33220 and/or 33224.
  
  Following our review of medical record information, the codes above may be denied as not medically necessary.

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 services on and after March 14, 2019.

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.

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