Medical Policy Revision: Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty

Effective January 21, 2020, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty.

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 January 21, 2020 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO), or Medicare Advantage (MA) plans will be processed as follows.

• The services represented by CPT® codes 0559T,0560T,0561T or 0562T 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 January 21, 2020.

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

¹ The 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.