January 15, 2010
Pursuant to the New Jersey Department of Banking and Insurance (DOBI) Decision and
Order pertaining to Order Number A09-113, Horizon Blue Cross Blue Shield of New Jersey
is revising our policy regarding the consideration of Evaluation and Management (E&M)
services and physical therapy modalities for reimbursement separate from the reimbursement
of Chiropractic Manipulative Therapy (CMT) codes.
Horizon BCBSNJ is in the process of implementing Order Number A09-113, which requires
that we evaluate whether E&M and/or physical therapy modality services billed by you are
separately compensable from the CMT and other services billed by you.
Horizon BCBSNJ will engage the services of an external vendor to help us implement this
Order. We will advise you of further details regarding this vendor in the next 30 days.
Our goal is to implement this Order with the least amount of administrative burden and/or
inconvenience to your office and to our members.
Please be advised that any claims that have been processed for dates of service on or after
October 7, 2009 that are not in compliance with this Order, as well as any appeals that have
been received by Horizon BCBSNJ relating to dates of service on or after October 7, 2009,
will be evaluated for consideration within the next 90 days. Any additional reimbursement
amounts will be paid with interest, in accordance with New Jersey Law, based upon the
receipt date of the original claim.
The evaluation of E&M services and physical therapy modalities may require the submission
of portions of your patients’ medical records to support the appropriateness of the services
Further communications outlining the details will be forthcoming.
James F. Albano - Vice President