We have completed our review of the additional CPT and HCPCS code changes for January 2019. These updates will be added to our claims processing system and are effective January 1, 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.

April 2019 HCPCS Code updates (Effective January 1, 2019) PF

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

• G2001-G2009
• G2013-G2015

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

• C9040

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

• C9044

The following service is subject to medical review for institutional and professional providers for Commercial products:

• C9045