Medical Policy Update: Meniscal Allografts and Other Meniscal Implants
Effective November 8, 2018, claims for certain services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans will also be processed according to our medical policy, Meniscal Allografts and Other Meniscal Implants (which currently only applies to claims for patients enrolled in Horizon BCBSNJ commercial plans).
Our medical policy, Meniscal Allografts and Other Meniscal Implants, has been updated to include reference to National Coverage Determination (NCD) 150.12: Collagen Meniscus Implant.
- Horizon BCBSNJ will follow this NCD and Centers for Medicare & Medicaid Services (CMS) guidelines in our processing of claims for services provided to Horizon BCBSNJ MA members.
- For those services where no NCD or Local Coverage Determination (LCD) exists, claims for services provided to MA members will be processed based on policy guidelines.
Access our Medical Policy Manual to review the Meniscal Allografts and Other Meniscal Implants medical policy.
Claims submitted for services provided on and after November 8, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.
- Medical record information may be requested to help us determine the medical appropriateness of CPT® code 29868 included on claims for services provided to Horizon BCBSNJ MA patients under age 50.
Following our review of medical record information, CPT code 29868 may be denied as not medically necessary.
- CPT code 29868 included on claims for services provided to Horizon BCBSNJ MA patients 50 years of age and over will be denied as an experimental/investigational service.
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 November 8, 2018.
CPT® is a registered mark of the American Medical Association.