Medical Policy Update: Artificial Pancreas Device System
Effective April 16, 2018, the guidelines of our medical policy, Artificial Pancreas Device System, will also be applied to certain claims for services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans. Presently the guidelines of this medical policy have not been applied to claims for services provided to MA members.
We encourage you to review this policy content in our Medical Policy Manual.
Based on the guidelines of our medical policy, Artificial Pancreas Device System, claims for services provided on and after April 16, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.
- Claims that include HCPCS codes S1034, S1035, S1036 and/or S1037 will pend, regardless of the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed.
Services that do not meet the criteria outlined in our policy will be denied as experimental/investigative non-covered services.
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 on and after April 16, 2018.