Revisions to Medical Policies pertaining to Destruction by Neurolytic Agent

Effective April 1, 2021, Horizon BCBSNJ will change the way we consider certain claims based on updates to the following medical policies:

• Ablation of Peripheral Nerves to Treat Pain
• Ablation Procedures for Peripheral Neuromas
• Radiofrequency Joint Ablation/Denervation

Access our Medical Policy Manual to review the content of these medical policies.¹

Based on the submitted diagnosis code(s), claims submitted for services provided on and after April 1, 2021 to patients enrolled in Horizon BCBSNJ commercial and Administrative Services Only (ASO) employer plans will be processed as follows:

• The services represented by CPT® code 64640 may be denied as experimental/investigational non-covered services.
• Information may be requested to help us determine the medical appropriateness of the services represented by CPT® code 64640. Following our review of medical record information, these services may be denied as not medically necessary.

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