Additional CPT code changes
We have completed our review of the 20 de abril23 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 abril de 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:
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 abril23 CPT Updates:
Tenga en cuenta: Coverage and/or payment rules for code(s) below may be subject to change for Medicare Advantage Plans and/or Commercial Products.
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:
0364U 0365U 0366U 0367U 0368U 0369U 0370U 0371U 0372U 0373U 0374U 0375U 0376U 0377U 0378U 0379U 0380U 0381U 0382U 0383U 0384U 0385U 0386U