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Reimbursement Policy Announced: Autologous and Allogenic Bone Grafts

Beginning on April 1, 2015, Horizon Blue Cross Blue Shield of New Jersey will change how we consider claims related to autologous and allogenic bone grafts.

Claims for services provided April 1, 2015 and after to Horizon BCBSNJ members will be processed and reimbursed according to the guidelines of our reimbursement policy, Autologous and Allogenic Bone Grafts.

Horizon BCBSNJ will not recognize the application of Modifier 59 when appended to CPT® codes 20930 or 20936 when those services are performed on the same date for the same patient by the same provider as one of the following primary procedure codes: 22319, 22532, 22548 - 22558, 22590 - 22612, 22630, 22633, 22634 or 22800 - 22812.

CPT codes 20930 or 20936 will not be considered for additional reimbursement when performed on the same date as, or in conjunction with, one of the primary procedure codes listed above even when appended with Modifier 59. Reimbursement for these services will be considered included in the allowance for the primary procedure code.

Participating physicians and other health care professionals may not seek reimbursement from our members for denials of these incidental services.

Review our Autologous and Allogenic Bone Grafts reimbursement policy online.

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 April 1, 2015.

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

Published on: December 29, 2014, 08:00 a.m. ET
Last updated on: November 24, 2020, 23:25 p.m. ET