Medical Policy Update: Injectable Bulking Agents for the Treatment of Urinary Incontinence
Effective April 13, 2018, the guidelines of our medical policy, Injectable Bulking Agents for the Treatment of Urinary Incontinence, 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. 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, Injectable Bulking Agents for the Treatment of Urinary Incontinence, and the submitted diagnosis code(s), claims for services provided on and after April 13, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.
- Claims that include CPT® code 51715 and/or HCPCS codes L8603, L8606, Q3031 may pend while information required to determine medical appropriateness is requested and reviewed.
- CPT code 51715 may be denied as a not medically necessary service.
- HCPCS codes L8603 and/or L8606 may 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 April 13, 2018.
CPT® is a registered mark of the American Medical Association.