We have completed our review of the additional CPT and HCPCS code changes for 20 de janeiro19. These updates will be added to our claims processing system and are effective 1 de janeiro, 2019. The lists include codes that have special coverage or payment rules for standard products. (Some employers may customize their benefits.) We have included codes for services that are:

• “Not Covered" – This includes services not covered in the main member certificate (e.g., covered as a prescription drug).
• “Not Medically Necessary" – This indicates services where there is insufficient evidence to support.
• “Not Separately Reimbursed" – Services that are not separately reimbursed are generally included in payment for another service or are reported using another code and may not be billed to your patient.
• “Subject to Medical Review" – Preauthorization is recommended for Commercial products and required for BlueCHiP for Medicare.
• “Invalid" – Use alternate procedure codes, such as a CPT or HCPCS code.
• “Medicare Lab Network" – Codes that are reimbursed to a hospital laboratory outside of the laboratory network, physicians, or urgent care center providers for BlueCHiP for Medicare.
• “Pending CMS determination" – For BlueCHiP for Medicare Category III codes.

Please submit your comments and concerns regarding coverage and payment designations to:

Blue Cross & Blue Shield of Rhode Island

Attention: Medical Policy, CPT Review

500 Exchange Street

Providence, Rhode Island 02903

Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them.

*CPT is a registered trademark of the American Medical Association.

20 de abril19 HCPCS Code updates (Effective 1 de janeiro, 2019) PF

The following codes are not separately reimbursed for Professional and Institutional providers for BlueCHiP for Medicare and Commercial products:

• G2001-G2009
• G2013-G2015

The following code is not covered for BlueCHiP for Medicare and not medically necessary for Commercial products for Professional and Institutional providers:

• C9040

The following service is subject to medical review for institutional and professional providers for BlueCHiP for Medicare and Commercial products:

• C9044

The following service is subject to medical review for institutional and professional providers for Commercial products:

• C9045