We have completed our review of the additional CPT and HCPCS code changes for 20 de enero20. These updates will be added to our claims processing system and are effective 1 de enero de 2020. The lists include 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.
• “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:

Correo electrónico: 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 enero20 CPT code updates    

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

K1003       K1004     

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:

20560       20561       80145       80230       80280       92549       C9758       K1001       K1002      

The following code is not covered for professional and institutional providers for BlueCHiP for Medicare:

K1005             

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

0570T       0584T       0585T       0586T      

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

98970       98971       98972       99421       99422       99423       99458       99473       99474

G2058      G2061       G2062       G2063      G2064       G2065  

The following code is not separately reimbursed for professional providers for BlueCHiP for Medicare and commercial products: 

B4187

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

A4226       E2398       L8033      

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

78434       78830       78831       78832     81277       81307       81308       81309       81522

81542       93356       C9757       E0787     J9309        L2006      

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

90912       90913       0591T       0592T       0593T      

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

0563T       0564T       0565T       0566T       0567T       0568T       0569T       0571T       0572T       0574T        0575T       0576T       0577T       0578T       0579T       0581T       0582T       0583T       0587T       0589T       0590T       0139U      0140U      0141U       0142U      0143U       0144U      0145U      0146U       0147U           0148U      0149U      0150U      0151U        0152U     0153U       0154U      0155U      0156U       0157U      0158U      0159U      0160U       0161U       0162U

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

0573T       0580T       0588T        C9055       J9199

The following codes are invalid for professional and institutional providers for BlueCHiP for Medicare:

0584T       0585T       0586T