Medical Policy Revision: Intraoperative Radiation Therapy

Effective March 16, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for intraoperative radiation therapy.

Based on the guidelines of our revised medical policy, Intraoperative Radiation Therapy, CPT® codes 77424, 77425 and 77469 submitted on claims for services provided on and after March 16, 2015 that include one or more of the diagnosis codes listed below will be denied as investigational services.

ICD-9 diagnosis codes:
154.0, 154.1, 154.2, 154.3, 154.8, 230.4

ICD-10 diagnosis codes:
C19, C20, C21.0, C21.1, C21.2, C21.8, D01.1, D01.2

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 March 16, 2015.

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