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