Medical Policy Update: Electrostimulation and Electromagnetic Therapy for Treating Wounds

Effective April 16, 2018 , the guidelines of our medical policy, Electrostimulation and Electromagnetic Therapy for Treating Wounds, 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, Electrostimulation and Electromagnetic Therapy for Treating Wounds, 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 G0281, G0282, G0329, G0295, and/or E0769 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 not medically necessary.

Please note that based on the guidelines of this medical policy, HCPCS codes G0281, G0282, G0329, G0295, and/or E0769 included on claims for services provided to patients enrolled in plans other than Horizon BCBSNJ MA plans will continue to be denied as experimental/investigational non-covered services regardless of the submitted diagnosis.

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.