Horizon BCBSNJ

Medical Policy Revision:  Intraoperative Neurophysiologic Monitoring, Electromyography and Nerve Conduction Studies.


Effective May 7, 2020, Horizon BCBSNJ will change consideration of certain professional claims based on revisions to medical policies:  Electromyography and Nerve Conduction Studies and Intraoperative Neurophysiologic Monitoring.


Access the Medical Policy Manual to review this medical policy content.


Claims submitted for services provided on and after May 7, 2020 to patients enrolled in Horizon BCBSNJ commercial and Administrative Services Only (ASO) plans will be processed as follows.

  • Regardless of the submitted diagnosis code(s), the information will be requested to determine the medical appropriateness of the services represented by CPT codes 95912 or 95913.
  • Regardless of the submitted diagnosis code(s), the information will be requested to determine the medical appropriateness of the services represented by CPT codes 9258595865959079590895909959109591195925959269592895929+95940+95941 or HCPCS code G0453.
Based on this policy implementation, claims submitted for services provided on and after May 7, 2020 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.
  • Regardless of the submitted diagnosis code(s), information will be requested to determine the medical appropriateness of the services represented by CPT codes 95829 or 95955.

Following the review of medical record information, these services may be denied as not medically necessary or as experimental/investigational non-covered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will apply to claims for dates of service on and after May 7, 2020.

Source:

https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-revision-electromyography-and-nerve-conduction-studies-0

https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-implementation-intraoperative-neurophysiologic-monitoring