Medical Policy Revision: Myoelectric Prosthetic Components for the Upper Limb

Effective September 11, 2018, Horizon Blue Cross Blue Shield of New Jersey will implement revisions to our medical policy, Myoelectric Prosthetic Components for the Upper Limb.

The revised policy guidelines may result in changes to the way we consider certain claims for services/supplies provided to your Horizon BCBSNJ patients.

We encourage you to visit our Medical Policy Manual to review the guidelines of this revised policy.

Based on the guidelines or our medical policy, Myoelectric Prosthetic Components for the Upper Limb, claims for services/supplies provided on and after September 11, 2018 will be processed as follows.

• HCPCS code L6026 will be denied, regardless of the submitted diagnosis code(s), as an experimental/investigational, non-covered service/supply.

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 September 11, 2018.