HMH Maestro

Payor Updates

Horizon Blue Cross Blue Shield and Medicare Advantage: Reimbursement Updates

Hackensack Meridian Health Medical Group

Effective June 15, 2021, Horizon Blue Cross Blue Shield (BCBS) of New Jersey has expanded their Consultation Services reimbursement policy to include commercial products and is fully aligned with Centers for Medicare & Medicaid Services for services rendered in office or emergency departments.

Horizon will not reimburse providers for consultation codes 99241-99245 for commercial and Medicare Advantage products when billed in office or emergency departments

Services will be considered for reimbursement when submitted utilizing appropriate new or established evaluation and management code (99202-99205: 99211-99215: 99281-99285) based on documentation. 

Click here for the Horizon BCBS of NJ Consultation Reimbursement Policy Guidelines.