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Medical Policy Revision: Refractive Keratoplasty Procedures

Effective May 31, 2018, the guidelines of our medical policy, Refractive Keratoplasty Procedures, will also be applied to certain claims for services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans.

We encourage you to access our Medical Policy Manual to review the guidelines this medical policy.


Based on the guidelines included in our medical policy, Refractive Keratoplasty Procedures, and the submitted diagnosis code(s), claims for services provided on and after May 31, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

  • Professional claims that include CPT® codes 65760, 65765, 65767, 65771, 65772, and/or 65775 may pend while information required to determine medical appropriateness is requested and reviewed.

    Following review, CPT codes may be denied as experimental/investigational services if policy criteria are not met.
     
  • CPT codes 65760, 65765, 65767, 65771, 65772 and/or 65775 may be denied as services not related to the submitted diagnosis codes(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 for dates of service on and after May 31, 2018.

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

Published on: April 30, 2018, 09:51 a.m. ET
Last updated on: April 30, 2018, 10:00 a.m. ET