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Medical Policy Revision: Transcatheter Mitral Valve Repair

Effective November 10, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for transcatheter mitral valve repair services provided to Horizon BCBSNJ Medicare Advantage (MA) plan members.

The Transcatheter Mitral Valve Repair medical policy identifies when mitral valve repair with a device cleared by the U.S. Food and Drug Administration is considered medically necessary or investigational.

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


Based on the guidelines of our medical policy, Transcatheter Mitral Valve Repair, claims submitted for services provided on and after November 10, 2017 to Horizon BCBSNJ MA plan members that include CPT® codes 33418, +33419 and/or 0345T will pend, regardless of the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed.

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 10, 2017.

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

Published on: October 10, 2017, 09:38 a.m. ET
Last updated on: October 10, 2017, 09:39 a.m. ET