Medical Policy Revision: Injectable Bulking Agents for the Treatment of Urinary Incontinence
Effective September 14, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for the treatment of urinary incontinence.
Based on the guidelines of our revised medical policy, Injectable Bulking Agents for the Treatment of Urinary Incontinence, claims submitted for services provided on and after September 14, 2015 that include CPT® code 51715 or HCPCS codes L8603, L8606, Q3031 and one or more of the diagnosis codes listed below will pend while information required to determine medical necessity is requested and reviewed.
ICD-9 diagnosis codes:
599.82, 625.6, 788.30, 788.32, 788.33, 788.34, 788.39
ICD-10 diagnosis codes:
N36.42, N39.3, N39.42, N39.46, N39.498, R32
Review this revised policy in our online Medical Policy Manual.
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 September 14, 2015.
CPT® is a registered mark of the American Medical Association.