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1 Jul, 2022

CPT code changes

We have completed our review of the 20 de julho22 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 julho, 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 julho22 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.

20 de julho22 CPT Updates:

Please note: Coverage and/or payment rules for code(s) below may be subject to change for Medicare Advantage Plans and/or Commercial Products.

The following code(s) are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and are not medically necessary for Commercial products: 

0323U   0324U   0325U   0326U   0328U   0329U   0330U   03331U   0714T   0716T    0717T   0718T   0719T    0720T    0721T   0723T   0730T    0731T    0732T      0733T   0734T    0736T    0737T   C9094   C9095   C9096   C9097   C9098   J1306   J1551   J2356   J2779   J9331    J9332   G0309

The following code(s) are covered and will not be separately reimbursed for Institutional providers for Medicare Advantage Plans and not medically necessary for Commercial products: 

0715T   0722T  0724T   0735T    A9596    A9601

The following code is not covered for Professional and Institutional providers for Medicare Advantage Plans (Pharmacy Benefit only): 

90584

The following code(s) is subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and is not covered for Professional and Institutional providers for Commercial Products (Pharmacy Benefit only for Commercial Products): 

J1551

The following code(s) are covered when filed with a covered diagnosis and will not be separately reimbursed for Institutional providers for Medicare Advantage Plans and Commercial Products:

Q4259   Q4260   Q4261

The following code(s) are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans:

G0308

 

 

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