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Medical Policy Update: Gait Trainers and Standing Frames

Effective December 15, 2020, Horizon BCBSNJ will change the way we consider certain claims for gait trainers and standing devices.

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

Claims submitted for services provided on and after December 15, 2020 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows:

  • Regardless of the submitted diagnosis codes the services represented by HCPCS codes E8000, E8001, E8002 or E0638 will be denied as 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 15, 2020.

The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ Medicare Advantage 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 Medicare Advantage members. For those services where no LCD or NCD exists, claims for Horizon BCBSNJ Medicare Advantage members will be processed based on our policy guidelines.

Published on: November 13, 2020, 01:24 a.m. ET
Last updated on: April 27, 2021, 22:51 p.m. ET