Medical Policy Update: Removal of Benign Skin Lesions
Effective June 6, 2019, Horizon BCBSNJ will change the way we consider certain professional claims for services provided to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans based on updates to our medical policy, Removal of Benign Skin Lesions.
Access our Medical Policy Manual to review this medical policy content.¹
Claims submitted for services provided on and after June 6, 2019 to patients enrolled in Horizon BCBSNJ MA plans will be processed as follows.
- Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT codes 17106, 17107 and 17108. Following our review of medical record information, these services may be denied as not medically necessary.
- Based on the submitted diagnosis code(s), CPT codes 17106, 17107 or 17108 may be denied as cosmetic 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 for dates of service on and after June 6, 2019.
CPT® is a registered mark of the American Medical Association.
¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA 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 MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.