Medical Policy Update: Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions

Effective November 10, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for Extracorporeal Shock Wave Therapy (ESWT) services provided to Horizon BCBSNJ Medicare Advantage (MA) plan members.

The Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions medical policy identifies when ESWT services are considered medically necessary or investigational.

We encourage you to review this policy in our Medical Policy Manual.

Based on the guidelines of our medical policy, Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions, CPT® codes 28890, 0019T, 0101T and/or 0102T included on claims for services provided on and after November 10, 2017 to patients enrolled in Horizon BCBSNJ MA plans will be denied as experimental/investigational services regardless of 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 for dates of service on and after November 10, 2017.

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