We have completed our review of the 20 de outubro20 CPT code changes including any category II performance measurement tracking codes and category II temporary codes for emerging technology. These updates will be added to our claims processing system and are effective 1 de outubro, 2020. The list includes 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:

Email: 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.

Additional 20 de outubro20 CPT code updates  PF

The following codes are subject to medical review for professional and institutional providers for BlueCHiP for Medicare and not medically necessary for professional and institutional providers for commercial products:

0015M    0016M

20 de outubro20 HCPCS code updates  PF

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

J3241

The following codes are subject to medical review for professional and institutional providers for commercial products only:

C9062    C9064          C9065 C9066   J1632   J3032           J9227    J9304

The following code is not covered for professional and institutional providers for BlueCHiP for Medicare and commercial products:

V2524

The following codes are not separately reimbursed for institutional providers for BlueCHiP for Medicare and commercial products:

Q4249  Q4250   Q4254         Q4255