We have completed our review of the 20 de abril22 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 abril, 2022. 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 it.
• “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.

20 de abril22 CPT updates                  

Please note: Coverage and/or payment rules for codes below may be subject to change for Medicare Advantage plans and/or commercial products.

The following codes are subject to medical review for professional and institutional providers for Medicare Advantage plans and commercial products effective 1 de abril, 2022:

C9091   C9093   J0491    J9273   J9359   Q5124

The following code is subject to medical review for professional and institutional providers for Medicare Advantage plans and commercial products effective 1 de maio, 2022:

J0879

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

J0219

The following code is subject to individual consideration review and is not separately reimbursed for institutional providers for Medicare Advantage plans and commercial products:

A4100

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

A2011    A2012    A2013   A4238  E2102

The following codes are covered when filed with a covered diagnosis and will not be separately reimbursed for institutional providers for Medicare Advantage plans and commercial products:

Q4224   Q4225    Q4256   Q4257   Q4258

The following codes are not covered for professional and institutional providers for Medicare Advantage plans and not medically necessary for professional and institutional providers for commercial products:

A9291   K1028    K1029   K1031   K1032   K1033

The following code is not covered for professional and institutional providers for Medicare Advantage plans. It will be covered and separately reimbursed to professional and institutional providers ONLY when related to essential pediatric vision eyewear. Otherwise, this code is not covered for commercial products:

V2525