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Medical Policy Revision: Intravenous Antibiotic Therapy for Lyme Disease

Effective June 27, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Intravenous Antibiotic Therapy for Lyme Disease.

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


Claims submitted for services provided on and after June 27, 2019 to patients enrolled in Horizon BCBSNJ Commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as follows:

  • Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by HCPCS code J0456.

    Following our review of medical record information, the services represented by J0456 code 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 dates of service on and after June 27, 2019.

¹The 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: March 28, 2019, 09:48 a.m. ET
Last updated on: March 28, 2019, 09:53 a.m. ET