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Changes in Allergy Testing guidelines for Horizon BCBSNJ effective from September 10, 2019

Effective September 10, 2019, Horizon BCBSN will change the way consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) members based on an update to our medical policy, Allergy Testing.

Based on the submitted diagnosis code(s), claims submitted for services provided on and after September 10, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

The services represented by CPT code 86003 may be denied as not medically necessary.
Information may be requested to help us determine the medical appropriateness of the services represented by CPT code 86003. Following our review of medical record information, these services may be denied as not medically necessary.

Source: https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-update-allergy-testing-0
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