We have completed our review of the 20 de julho24 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, 2024. 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 julho24 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.

Additionally, coverage may vary for those Commercial Products that have opted out of the Biomarker Testing Mandate.

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

90637  90638  90684  0464U 0889T  0890T  0891T  0892T  

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:

0867T  0868T  0869T  0870T  0871T  0872T  0873T  0875T  0877T  0878T  0879T  0880T 

0881T  0882T  0883T  0884T  0885T  0886T  0887T  0888T  0897T  0898T  

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

0450U 0451U 0452U 0453U 0455U 0456U 0457U 0458U 0459U 0460U 0461U 0462U  0463U

0465U 0466U 0467U 0468U 0469U 0470U 0471U 0472U 0473U 0474U 0475U 0020M 

0874T  0876T  0899T  0900T

The following code(s) are covered when filed with ICD-10-CM range F01-F99, all other ICD-10-CM’s are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:

0454U

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

0882T  0883T

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

0877T  0878T  0879T  0880T  0881T  0887T  0893T  0894T  0895T  0896T  0897T  0898T