Medical Policy Revision: Lumbar Spinal Fusion

Effective November 15, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims services related to lumbar spine fusion surgery.

Our medical policy, Lumbar Spinal Fusion, identifies when lumbar spine fusion surgery is considered medically necessary and when it is considered investigational.

We encourage you to review this policy in our Medical Policy Manual.

Based on the guidelines of our revised medical policy, Lumbar Spinal Fusion, claims for services provided on and after November 15, 2017 that include CPT® code 22586 will pend, regardless of the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed.

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 November 15, 2017.

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