Medical Policy Update: Wearable Cardioverter-Defibrillators
Effective November 27, 2017, the guidelines of our medical policy, Wearable Cardioverter-Defibrillators, will be applied to claims for services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.
The guidelines of this policy identify when the use of a wearable cardioverter-defibrillator (WCD) is considered medically necessary.
We encourage you to review this revised policy in our Medical Policy Manual.
Based on the guidelines of our medical policy, Wearable Cardioverter-Defibrillators, AND the submitted diagnosis code(s), claims for services provided on and after November 27, 2017 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.
- Claims that include CPT® code 93745, and/or HCPCS codes K0606, K0607, K0608, K0609 may pend while information required to determine medical appropriateness is requested and reviewed.
- CPT® code 93745, and/or HCPCS codes K0606, K0607, K0608, K0609 included on claims may be denied as a service “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 on and after November 27, 2017.
CPT® is a registered mark of the American Medical Association.