We have completed our review of the 20 de enero21 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 were effective 1 de enero de 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 enero21 HCPCS code updates          

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

C9069 C9070 C9072 C9073 J1823   J7352   J9144   J9223   J9316   J9317

The following code is subject to medical review for professional and institutional providers for commercial products only:

Q5122

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

C9071 C9771

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

G2214 G2250 G2251 G2252