We have completed our review of the 20 de abril21 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 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 abril21 HCPCS code updates   

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

C9074 J1554  J9037  J9349  Q2053

The following codes are not medically necessary for Commercial Products and not covered for Medicare Advantage Plans for both covered for Professional and Institutional providers as there is insufficient evidence to determine the effects of the technology on health outcomes:

C9777   J1427    J7402  K1013    K1016    K1017    K1018  K1019    K1020   S1091

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

G2211

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

A9592   C9776   K1014   K1015