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Medical Policy Revision: Laboratory Tests for Heart Transplant Rejection

Effective December 17, 2019, Horizon BCBSNJ will change the way we consider certain professional and facility claims based on revisions to our medical policy, Laboratory Tests for Heart Transplant Rejection.

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


Regardless of the submitted diagnosis code(s), claims submitted for services provided on and after December 17, 2019 to patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only (ASO) plans will be processed as follows.

  • The services represented by CPT® codes 0055U, 0087U and 0088U will be denied as experimental/investigational, non-covered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after December 17, 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.

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

Published on: September 16, 2019, 02:37 AM ET
Last updated on: September 13, 2019, 04:17 AM ET