We have completed our review of the 20 de junho21 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, 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 julho21 HCPCS code updates     

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

0640T      0641T     0642T     0643T     0644T     0645T     0646T     0647T     0648T     0649T     0650T      0651T     0652T     0653T     0654T     0655T     0656T     0657T     0658T     0659T     0660T      0248U    0249U     0250U     0251U     0252U     0253U   

The following code is subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial products:

0661T

The following code is not covered for Professional and Institutional provider for Medicare Advantage Plans and Commercial products:

0254U

The following codes are not separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial products: 

0662T     0663T

The following code is not covered for Professional and Institutional providers for Medicare Advantage Plans; pharmacy benefit only:

90758