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Medical Policy Revision: Urine Drug Testing in Pain Management and Substance Abuse Treatment Setting

Effective March 14, 2019, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims based on revisions to our medical policy, Urine Drug Testing in Pain Management and Substance Abuse Treatment Setting.

Access our Medical Policy Manual to review this medical policy content.¹


Claims submitted for services provided to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) and Medicare Advantage (MA) plans on and after March 14, 2019 will be processed as noted below.

  • CPT® codes 82542, 83992 and/or 84311 included on professional claims may be denied, based on the submitted diagnosis code(s), as non-covered services.
     
  • HCPCS code P2031 included on facility claims will be denied, regardless of the submitted diagnosis code(s), as an experimental/investigational, non-covered service.

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 March 14, 2019.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

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

Published on: December 12, 2018, 11:57 a.m. ET
Last updated on: December 12, 2018, 14:45 p.m. ET