Medical Policy Update: Regional Sympathetic Blocks

Effective February 8, 2018, the guidelines of our medical policy, Regional Sympathetic Blocks, will be applied to claims for services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans.

We encourage you to access our Medical Policy Manual to review the guidelines of our medical policy, Regional Sympathetic Blocks, which identify when the use of regional sympathetic blocks (Stellate Ganglion Blocks and Lumbar Sympathetic Blocks) are considered medically necessary. Beginning February 8, 2018, the guidelines of this policy will also apply to patients enrolled in Horizon BCBSNJ MA plans.

Based on the guidelines of our medical policy, Regional Sympathetic Blocks and the submitted diagnosis code(s), claims for services provided on and after February 8, 2018 to members enrolled in Horizon BCBSNJ MA plans that include CPT^® codes 64510 and/or 64520 will pend while information required to determine medical appropriateness is requested and reviewed.

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 February 8, 2018.

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