Medical Policy Update: Percutaneous Vertebroplasty and Sacroplasty
Effective January 18, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for certain vertebroplasty or sacroplasty services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.
We encourage you to access our Medical Policy Manual to review the guidelines of our medical policy, Percutaneous Vertebroplasty and Sacroplasty1, which identify when these services are considered medically necessary.
Based on the guidelines of our medical policy, Percutaneous Vertebroplasty and Sacroplasty, and the submitted diagnosis code(s) claims for services provided on and after January 18, 2018 to patients enrolled in Horizon BCBSNJ MA plans will be processed as noted below:
- Claims that include CPT® codes 22510, 22511, +22512, 22513, 22514 and/or +22515 may pend while information required to help us determine if the service is to be considered medically necessary is requested and reviewed.
- CPT codes 22510, 22511, +22512, 22513, 22514 and/or +22515 included on claims may be denied as a service that is “not related” to 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 January 18, 2018.
1Previous policy titled Percutaneous Vertebroplasty, Balloon Kyphoplasty, Mechanical Vertebral Augmentation and Sacroplasty.
CPT® is a registered mark of the American Medical Association.