Medical Policy Revision: Periureteral Bulking Agents as Treatment of Vesicoureteral Reflux (VUR)
Effective April 13, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for periureteral bulking agents.
Based on the guidelines of our revised medical policy, Periureteral Bulking Agents as Treatment of Vesicoureteral Reflux (VUR), claims submitted for services provided April 13, 2015 and after that include CPT® code 52327, HCPCS code L8603 or HCPCS code L8606, and one or more of the diagnosis codes listed below will pend while information to determine medical appropriateness is requested and reviewed.
- ICD-9 diagnosis codes: 593.70, 593.71, 593.72, 593.73
- ICD-10 diagnosis codes: N13.70, N13.71, N13.721, N13.731, N13.722, N13.732, N13.729 or N13.739
Codes 52327, L8603 or L8606 when submitted with diagnosis codes other than those noted above will be denied as investigational services.
Review this revised policy in our online Medical Policy Manual.
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 April 13, 2015.
CPT® is a registered mark of the American Medical Association.