We have completed our review of the additional CPT and HCPCS code changes for 20 de janeiro20. These updates will be added to our claims processing system and are effective 1 de janeiro, 2020. 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:
E-mail: Medical.Policy@bcbsri.org
Mail:
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 janeiro20 CPT code updates
The following codes are not covered for professional and institutional providers for BlueCHiP for Medicare and commercial products:
K1003 K1004
The following codes are not covered for professional and institutional providers for BlueCHiP for Medicare and not medically necessary for professional and institutional providers for commercial products:
20560 20561 80145 80230 80280 92549 C9758 K1001 K1002
The following code is not covered for professional and institutional providers for BlueCHiP for Medicare:
K1005
The following codes are not medically necessary for professional and institutional providers for commercial products:
0570T 0584T 0585T 0586T
The following codes are not separately reimbursed for professional and institutional providers for BlueCHiP for Medicare and commercial products:
98970 98971 98972 99421 99422 99423 99458 99473 99474
G2058 G2061 G2062 G2063 G2064 G2065
The following code is not separately reimbursed for professional providers for BlueCHiP for Medicare and commercial products:
B4187
The following codes are not separately reimbursed for institutional providers for BlueCHiP for Medicare and commercial products:
A4226 E2398 L8033
The following codes are subject to medical review for professional and institutional providers for BlueCHiP for Medicare and commercial products:
78434 78830 78831 78832 81277 81307 81308 81309 81522
81542 93356 C9757 E0787 J9309 L2006
The following codes are subject to medical review for professional and institutional providers for BlueCHiP for Medicare not covered for commercial products:
90912 90913 0591T 0592T 0593T
The following codes are subject to medical review for professional and institutional providers for BlueCHiP for Medicare not medically necessary for commercial products:
0563T 0564T 0565T 0566T 0567T 0568T 0569T 0571T 0572T 0574T 0575T 0576T 0577T 0578T 0579T 0581T 0582T 0583T 0587T 0589T 0590T 0139U 0140U 0141U 0142U 0143U 0144U 0145U 0146U 0147U 0148U 0149U 0150U 0151U 0152U 0153U 0154U 0155U 0156U 0157U 0158U 0159U 0160U 0161U 0162U
The following codes are subject to medical review for professional and institutional providers for commercial products:
0573T 0580T 0588T C9055 J9199
The following codes are invalid for professional and institutional providers for BlueCHiP for Medicare:
0584T 0585T 0586T