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1 oct, 2021

CPT code changes

We have completed our review of the 20 de octubre21 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 octubre 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 octubre21 HCPCS code updates          

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:

0255U   0256U   0257U   0258U   0259U   0260U   0261U   0262U   0263U   0264U           0265U   0266U   0267U   0268U   0269U   0270U   0271U   0272U   0273U   0274U   0275U   0276U   0277U   0278U   0279U   0280U   0281U   0282U   0283U   0284U   0018M

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