We have completed our review of the 20 de janeiro21 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 janeiro, 2021. 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 janeiro21 CPT updates 

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

30468        55880          81529        92229            92517           92518          92519                   

The following codes are not medically necessary for professional and institutional providers for commercial products:

0628T        0630T      

The following codes are not separately reimbursed for professional and institutional providers for BlueCHiP for Medicare and commercial products: 

57465        76145         99439 

The following codes are subject to medical review for professional and institutional providers for BlueCHiP for Medicare and commercial products:

69705**       69706**     71271          81168       81191      81192     81193        81194        81278    

81279           81338          81339         81347       81348      81351     81352        81353        81357    

81360           81419          81546         0633T       0634T     0635T     0636T       0637T       0638T    

The following codes are subject to medical review for professional and institutional providers for BlueCHiP for Medicare, and are not medically necessary for commercial products:

81554        0620T         0621T       0622T        0623T        0624T        0625T        0626T       0627T         0629T       0631T         0632T         0639T        0227U       0228U        0229U       0230U         0231U       0232U        0233U      0234U         0235U       0236U       0237U        0238U         0239U       0017M

The following code is subject to individual consideration review for professional and institutional providers for BlueCHiP for Medicare and commercial products:

99417

**Effective 01/03/2021