Medical Policy Update: Confocal Laser Endomicroscopy

Effective April 12, 2018, the guidelines of our medical policy, Confocal Laser Endomicroscopy, 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, Confocal Laser Endomicroscopy, claims for services provided on and after April 12, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

• CPT^® code 0397T will, regardless of the submitted diagnosis code(s), be denied as a not medically necessary service.

• CPT code 88375 may, based on the submitted diagnosis code(s), be denied as not related to the submitted diagnosis code(s).

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 12, 2018.

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