Outpatient Laboratory Claims: Referring Practitioner Required In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory… Read More »Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims
Effective September 26, 2019, Horizon BCBSNJ will change the way consider certain professional claims for smoking cessation services provided September 26, 2019. In accordance with CMS… Read More »BCBS – New Reimbursement Guidelines for Smoking Cessation effective from September 26, 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… Read More »Changes in Allergy Testing guidelines for Horizon BCBSNJ effective from September 10, 2019
Beginning with dates of service on or after November 1, 2019, new Inter-professional CPT codes 99451 and 99452 are not eligible for reimbursement when they… Read More »BCBS Reimbursement Policy Update: Bundled Services-Professional
For individual providers who submit electronic claims with their Employee Identification Number (EIN) rather than their Social Security Number (SSN), a new policy from Florida… Read More »Florida Blue – Type 2 NPI is Required for Providers Billing with EIN
Effective for the date of services from August 1, 2014, Florida Blue will implement a new coding edit that affects payment for multiple diagnostic cardiology procedures… Read More »Florida Blue follows Medicare edits for Multiple Diagnostic Procedures
Effective April 13, 2012, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) will no longer reimburse separately for the Current Procedural Terminology (CPT) 99051.… Read More »BCBS Florida After Hours and Weekend Care Payment Policy CPT codes 99050, 99051, 99053, 99056, 99058 and 99060
Does BCBS follow Medicare guidelines? Yes, BCBS follows Medicare NCCI edits and the same has been incorporated into BCBS editing system. BCBS considers CMS NCCI… Read More »Does BCBS insurance follows Medicare NCCI edits
Epidural Injections The total number of epidural, subarachnoid, or caudal injections (62310 and 62311) are limited to three (3) in six (6) months and are… Read More »Florida BCBS Reimbursement and Limitations for Injections
The following is a list of combinations that Blue Cross and Blue Shield of Florida has determined are not appropriately reported together with modifier 59… Read More »BCBS FL Limited Code Combinations