Medical Policy Revision: Insulin Infusion Pumps

Effective April 17, 2019, Horizon BCBSNJ will change the way we process claims for certain services/supplies provided to members enrolled in Horizon BCBSNJ Commercial plans based on revisions to our medical policy, Insulin Infusion Pumps.

Additionally, effective April 17, 2019, we will begin to process claims for services/supplies provided to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) per this policy content.¹

Access our Medical Policy Manual to review this policy content.

Based on the contents of our revised medical policy, claims for services provided on and after April 17, 2019 will be processed as noted below.

• HCPCS code A4220 submitted on claims for services/supplies provided to patients enrolled in Horizon BCBSNJ Commercial plans will be denied, regardless of the submitted diagnosis code(s), as experimental/investigative, non-covered services.

• HCPCS codes A9276, A9277 and/or A9278 submitted on claims for services/supplies provided to patients enrolled in Horizon BCBSNJ MA plans will be denied, regardless of the submitted diagnosis code(s), 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 dates of service on and after April 17, 2019.

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

¹ Horizon BCBSNJ medical policies that apply to claims for services provided to Horizon BCBSNJ MA members include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). Horizon BCBSNJ follows NCD, LCD and Centers for Medicare & Medicaid Services (CMS) guidelines when processing claims for Horizon BCBSNJ MA members. For procedures/services where no LCD or NCD exists, claims for services provided to MA members will be processed based on our policy guidelines.