P F
1 Jul, 2023

CPT code changes

We have completed our review of the 20 de julho23 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, 2023. 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 julho23 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 covered and are separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:

J0137   J0206   J0216   J0457   J0665   J0736   J0737   J1805   J1806   J1811   J1812   J1813   J1814

J1836   J1920   J1921   J1961   J2249   J2305   J2371   J2372   J2427   J2561   J2598   J2599

J2806   J7213   J9259   J9322   J9323  

The following code(s) are covered under the pharmacy benefit only and are separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:

J1941   Q5131

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

C9151 J1440   J1576   J2329   J9029   J9056   J9058   J9059   J9063   J9347   J9380   J9381

The following code(s) are subject to medical review for Professional and Institutional providers for Commercial Products only (Pharmacy Benefit):

J9350

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

C9150 C9784 C9785 C9786 C9787

For the following code, an alternate code is required for Professional providers only for Medicare Advantage Plans and Commercial Products:

C9151

The following code(s) are not separately reimbursed for Professional providers or Institutional providers for Medicare Advantage Plans and Commercial Products:

C9150

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

Q4272 Q4273 Q4274 Q4275 Q4276 Q4277 Q4278 Q4280 Q4281 Q4282 Q4283 Q4284