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Reimbursement Policy Implementation: Microsurgery and Robotic Surgery

Effective June 1, 2020, Horizon BCBSNJ will change the way we consider certain professional claims for services provided on and after June 1, 2020 based on the guidelines of our reimbursement policy Microsurgery and Robotic Surgery.

We encourage you to review our Microsurgery and Robotic Surgery policy.

Professional claims submitted for services provided on and after June 1, 2020 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans, Horizon BCBSNJ fully insured commercial plans and Administrative Services Only (ASO) employer groups that have opted-in to the guidelines of this policy will be processed as follows.

Regardless of the submitted diagnosis code(s), the robotic or microsurgical technique represented by HCPCS code S2900 and CPT® code 69990 will be denied as non-covered services as the reimbursement for these codes are considered included as part of our reimbursement of the surgical service(s).

Participating providers cannot balance bill members for these denied services.

Member benefits will not be impacted by this new policy. In addition, claims submitted for services rendered prior to June 1, 2020 will not be impacted.

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 services on and after June 1, 2020.

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

Published on: March 2, 2020, 01:04 a.m. ET
Last updated on: April 28, 2021, 05:10 a.m. ET