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Musculoskeletal Program Update

Effective December 15, 2017, the following procedure codes (implemented by the American Medical Association at the beginning of the 2017 calendar year), will be included as part of our Musculoskeletal Program for Spine Surgery Services, administered by eviCore healthcare (eviCore). This applies to members enrolled in Horizon BCBSNJ fully-insured products as well as Administrative Services Only (ASO) accounts that have elected the Musculoskeletal Program. The new codes fall into two categories, codes that are considered experimental or investigational (E&I) services and new device codes.

E&I Services Codes

The new E&I Services codes are as follows:

  • 0274T
  • 0275T
  • 22867
  • 22868
  • 22869
  • 22870
  • 62287
  • 62380

Based on Horizon BCBSNJ Medical Policy, these codes currently are, and until further notice will continue to be considered experimental and investigational services. As such, if these services are performed they will not be covered and claims for these codes will be denied. You are not required to submit a PA/MND request for these codes.

Device Codes

The following new device codes are included in this program effective December 15, 2017. However, if these devices are to be used in a spine surgery procedure, a PA/MND review of these devices will be performed in conjunction with the review of the concomitant spine surgery procedure. In most cases, if eviCore approves the medical necessity of the spine surgery procedure, the corresponding device will also be approved. If eviCore does not approve the medical necessity of the spine surgery procedure, the device will also not be approved.

  • 22853
  • 22854
  • 22859

Review the complete list of spine surgery services that require PA/MND reviews.

More information about our Musculoskeletal Program is available on HorizonBlue.com/musculoskeletal.

If you have questions, please contact your Network Specialist.

CPT® is a registered trademark of the American Medical Association.

Published on: November 17, 2017, 09:58 a.m. ET
Last updated on: November 17, 2017, 09:59 a.m. ET