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1 feb, 2019

CPT® and HCPCS Level II code changes

We have completed our review of the 20 de enero19 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 are effective 1 de enero de 2019. 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, 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:

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.

 Additional 20 de enero19 CPT code updates:

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

0080U        0082U        0083U

20 de enero19 HCPCS code updates:

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

A4563       A5514       A6460       A6461       A9589       E0447       E0467       L8608    L8698  L8701       L8702        

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

B4105       C8937       G0071       G0076       G0077       G0078       G0079       G0080    G0081       G0082                  G0083       G0084       G0085       G0086       G0087       G2010       G2011      G2012 

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

C1823       C9751   

The following services are subject to medical review for professional and institutional providers for Commercial products:

C9036             C9038             J0185       J0584       J1301      J1454       J2797       J3245       J9057                     J9173              J9311       J9312       Q5107     Q5109      Q5111    

*Review effective 1 de febrero de 2019

The following services are subject to medical review for professional and institutional providers for BlueCHiP for Medicare and Commercial products:

A9513        J0517           J0567       J3397         J3398         Q2042    

The following codes are invalid for professional providers for BlueCHiP for Medicare and Commercial products:

C9752       C9753          C9754       C9755         

The following codes are not covered for professional and institutional providers for BlueCHiP for Medicare and Commercial products; pharmacy benefit only:

J0599       J1628

Not covered for professional and institutional providers for Commercial products; pharmacy benefit only:

J7170

The following codes are not medically necessary for professional and institutional providers for Commercial products:

J7318       J7329 

Not covered for professional and institutional providers for BlueCHiP for Medicare and Commercial products: 

T4545

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

V5171       V5172       V5181        V5211        V5212       V5213        V5214        V5215       V5221