Medical Policy Revision: Treatment of Varicose Veins/Venous Insufficiency

Effective June 18, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain professional claims for the treatment of varicose veins and venous insufficiency .

We encourage you to visit our Medical Policy Manual to review the guidelines of our medical policy, Treatment of Varicose Veins/Venous Insufficiency, which identify when the use of homocysteine testing is considered medically necessary.

Based on the guidelines included in our medical policy, Treatment of Varicose Veins/Venous Insufficiency, claims for services provided on and after June 18, 2018 will be processed as follows:

• Claims submitted for services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans that include CPT^® codes 36465, 36466, 36470, 36471, 36473 and/or 36474 will pend, regardless of the submitted diagnosis code(s), while information to help us determine the medical necessity of the services in question are requested and reviewed.
• CPT codes 36482 and/or 36483 included on claims for services provided to patients enrolled in plans other than Horizon BCBSNJ MA plans will be denied as experimental/investigational non-covered services regardless of the submitted diagnosis code(s).
• Claims submitted for services provided to patients enrolled in Horizon BCBSNJ Commercial and MA plans that include CPT code 01520 may, based on the submitted diagnosis code(s), pend while the necessary information to determine the medical necessity of this service 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 June 18, 2018.

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