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Medical Policy Update: Allergy Testing

Effective September 10, 2019, Horizon BCBSN will change the way we consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) members based on an update to our medical policy, Allergy Testing.

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

Based on the submitted diagnosis code(s), claims submitted for services provided on and after September 10, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

  • The services represented by CPT® code 86003 may be denied as not medically necessary.
  • Information may be requested to help us determine the medical appropriateness of the services represented by CPT code 86003. Following our review of medical record information, these services may be denied as not medically necessary.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after September 10, 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: August 8, 2019, 15:23 p.m. ET
Last updated on: April 27, 2021, 10:37 a.m. ET