Medical Policy Implementation: Non-Invasive Home Positive Pressure Ventilation in Adults

Effective January 16, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for non-invasive home positive pressure ventilation.

Our medical policy, Non-Invasive Home Positive Pressure Ventilation in Adults, identifies when any type of home ventilator used with noninvasive interface would be considered medically necessary. We encourage you to review this policy in our Medical Policy Manual.

Based on the guidelines of our revised medical policy, Non-Invasive Home Positive Pressure Ventilation in Adults, claims that include HCPCS code E0466 for services provided on and after January 16, 2017 will pend, regardless of submitted diagnosis codes(s), while we request information to help us determine whether or not the home ventilator is considered medically necessary.

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 January 16, 2017.