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1 dic, 2018

CPT® and HCPCS Level II code changes

We have completed our review of the 20 de julio18 current procedural terminology (CPT) and HCPCS code changes
including any category II performance measurement tracking codes and category III temporary codes for emerging
technology. These updates will be added to our claims processing system and became effective 1 de julio de 2018. The lists
include 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.
  • “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, CPT or HCPCS code.
  • “Medicare Lab Network" – Codes that are reimbursed to a hospital laboratory outside of the laboratory network, physician 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:
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.

20 de octubre18 CPT Code updates

The following codes are not covered for Professional and Institutional providers for BlueCHiP for Medicare and not medically necessary for Professional and Institutional providers for Commercial products:

0062U 0063U 0064U 0065U 0066U 0067U 0068U 0069U 0070U
0071U 0072U 0073U 0074U 0075U 0076U 0077U 0078U 0079U

20 de octubre18 HCPCS updates

The following codes are not separately reimbursed for Professional and Institutional providers for BlueCHiP for Medicare and Commercial products:

G9978 G9979 G9980 G9981 G9982 G9983 G9984 G9985
G9986 G9987            

The following codes are subject to medical review for Professional and Institutional providers for Commercial products:

Q5108 Q5110 C9033

*CPT is a registered trademark of the American Medical Association.