Medical Policy Revision: Sacral Nerve Stimulation

Effective November 3, 2014, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for sacral nerve neuromodulation/stimulation.

Based on revisions to our medical policy, Sacral Nerve Neuromodulation/Stimulation, claims submitted for this service with diagnosis code 596.51 (hypertonicity of the bladder) for dates of service on and after November 3, 2014 will pend while information to determine medical necessity of this service is requested and reviewed.

This medical policy is available 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 November 3, 2014.