Medical Policy Revision: Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Disorders

Effective January 4, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for the use of oscillatory devices in the treatment of respiratory disorders and cystic fibrosis.

The guidelines of our revised medical policy, Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Disorders, identify when the use of an oscillatory device is considered medically necessary or investigational.

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

Based on the guidelines of our revised medical policy, Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Disorders, AND the submitted diagnosis code(s), claims for services provided on and after January 4, 2018 will be processed as noted below.

For services provided to Horizon BCBSNJ Medicare Advantage (MA) plan members:

• Claims that include HCPCS codes A7025, A7026 and/or E0483 may pend while information required for us to determine medical appropriateness is requested and reviewed.
   
• HCPCS codes A7025, A7026, E0480, E0483 or E0484 may be denied as “not related” to the submitted diagnosis code(s).
   
• HCPCS codes E0481 or S8185 may be denied as not medically necessary.
   

For services to members enrolled in all Horizon BCBSNJ plans other than Horizon BCBSNJ MA plans:

• HCPCS codes A7025, A7026, E0480, E0481, EO483, or E0484 may be denied as “not related” to the submitted diagnosis code(s).

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 on and after January 4, 2018.