We have completed our review of the 20 de enero22 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 2022. 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 enero22 CPT updates
Please note: Coverage and/or payment rules for codes 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:
43497 64628 64629 81560 0693T 0702T 0703T
The following codes are not medically necessary for Professional and Institutional providers for
Commercial products:
0676T 0678T 0690T 0701T 0709T
The following codes are not separately reimbursed for Institutional providers for Medicare Advantage Plans and Commercial products:
01937 01938 01937 01938 01939 01940 01941 01942
The following codes are not separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial products:
0699T 77090 77091 77092 93319 98975 98976 98977 98978 98980
98981 99424 99425 99426 99427 99437
The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial products:
64584 69726 69727 81349 81523 93593 93594 93595 93596 93597 0679T 0682T 0697T 0698T 0710T 0711T 0712T 0713T
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:
68841 0672T 0673T 0674T 0675T 0677T 0680T 0681T 0683T 0684T 0685T 0686T 0689T 0691T 0692T 0694T 0695T 0696T 0700T 0707T 0708T 0285U 0286U 0287U 0288U 0289U 0290U 0291U 0292U 0293U 0294U 0295U 0296U 0297U 0298U 0299U 0300U 0303U 0304U 0305U
The following codes are subject to medical review for Professional and Institutional providers for Commercial products:
33267 33269
The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and are not covered for Commercial products:
0687T 0688T 0704T 0705T 0706T