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Medical Policy Update: Cognitive Rehabilitation

Effective December 10, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on our inclusion of Horizon BCBSNJ Medicare Advantage (MA) claims in the scope of our medical policy, Cognitive Rehabilitation.

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


Claims submitted for services provided on and after December 10, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

  • Based on the submitted diagnosis code(s), the services represented by HCPCS code G0515 may be denied as experimental/investigational non-covered services.

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 December 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.

Published on: September 9, 2019, 02:29 AM ET
Last updated on: September 4, 2019, 05:24 AM ET