Medical Policy Update: Colorectal Cancer Screening

Effective June 4, 2018, the guidelines of our medical policy, Colorectal Cancer Screening, will also be applied to claims for services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans.

We encourage you to access our Medical Policy Manual to review the guidelines of our medical policy, Colorectal Cancer Screening.


Based on the guidelines of our medical policy, Colorectal Cancer Screening, claims for services provided on and after June 4, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

  • Claims that include CPT® codes 45378, 45379, 45380, 45381, 45384, 45385, 45330, 45331, 74270, 74280 and/or 82274 will pend, regardless of the submitted diagnosis code(s), while information to determine medical necessity is requested and reviewed.

    If our review determines that the policy criteria are not met, CPT® codes 45378, 45379, 45380, 45381, 45384, 45385, 45330, 45331, 74270, 74280 and/or 82274 will be denied as experimental/investigational, 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 June 4, 2018.

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

Published on: May 3, 2018, 09:41 AM ET
Last updated on: May 3, 2018, 10:44 AM ET