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PA/MND Update: Psychological and Neuropsychological Testing

Effective November 1, 2021 Horizon will no longer require prior authorization (PA) or medical necessity determination (MND) reviews (either pre-service or post-service) for Psychological and Neuropsychological testing services represented by CPT® codes 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139 or 96146 for your patients with behavioral health diagnoses.

This change applies to requests for services made on or after November 1, 2021.

This change only pertains to members enrolled in the following plans:

  • Horizon BCBSNJ fully insured commercial plans
  • Horizon BCBSNJ Medicare Advantage (including Braven HealthSM) plans

This change will NOT impact members enrolled in the following plans and authorization requests for these members should follow present-state processes:

  • Horizon BCBSNJ Administrative Services Only (ASO) group employer plans, including the New Jersey State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP)
  • Horizon NJ Health Medicaid Plans, including Medicaid Managed Care, NJ FamilyCare and Horizon NJ TotalCare (HMO D-SNP) plans

If you have questions, please call

  • 1-800-624-1110 to speak with a Horizon BCBSNJ Provider Services representative
  • 1-888-666-2535 to speak with a Horizon BCBSNJ Institutional Services representative
Published on: October 1, 2021, 11:25 a.m. ET
Last updated on: September 29, 2021, 11:27 a.m. ET