We have completed our review of the 20 de enero23 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 enero 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:

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 enero23 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 not covered for Professional and Institutional providers for Medicare Advantage Plans and not medically necessary for Professional and Institutional providers for Commercial products:

43290   98978  

The following codes are not medically necessary for Professional and Institutional providers for

Commercial Products and have medically necessary based on age restrictions for Medicare Advantage Plans:

22860

The following codes are not covered for Professional and Institutional providers for

Commercial Products:

92066

The following codes are not covered for Professional and Institutional providers for

Commercial Products and not covered under Part B for Medicare Advantage Plans:

90678

The following codes are medically necessary for Professional and Institutional providers for

Commercial Products based on diagnosis:

69729   69730  

The following codes are not medically necessary for Professional and Institutional providers for

Commercial Products:

22860   0772T   0774T   0777T      

The following codes are not separately reimbursed for Institutional providers for Medicare Advantage Plans and not medically necessary for Commercial Products:

0751T   0752T   0753T   0754T   0755T   0756T   0757T   0758T   0759T   0760T   0761T   0762T   0763T   0764T   0765T  

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

15853   15854   0770T

The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:

43291   69728   81418   81441   81449   81451   81456   0742T

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:

30469   03585U   0356U   0357U   0358U   0360U   0361U   0362U   0363U   0738T   0739T    0740T   0741T    0743T   0744T   0745T   0746T   0747T   0748T   0749T   0750T   0766T   0767T   0768T   0769T   0771T   0773T   0775T   0776T   0778T   0779T   0781T   0782T   0783T  

Effective 03/1/2023, the following code is subject to medical review for Professional and Institutional providers for both Medicare Advantage Plans and Commercial Products:

0359U