We have completed our review of the July additional CPT and HCPCS code changes. These updates have been added to our claims processing system and were effective July 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 by mail or email:

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.

July 2019 CPT and HCPCS code updates

The following services are subject to medical review for professional and institutional providers for BlueCHiP for Medicare and not medically necessary for commercial products:

0543T   0544T   0545T   0547T   0548T   0549T   0552T   0553T   0554T   0555T             

0556T   0557T   0558T   0084U   0085U   0086U   0087U   0088U   0089U   0090U  

0091U   0092U   0093U   0094U   0095U   0096U   0097U   0098U   0099U   0100U  

0101U   0102U   0103U   0104U

The following service is subject to medical review for professional providers and not separately reimbursed for institutional providers for BlueCHiP for Medicare; for commercial products, this service is not medically necessary for professional and institutional providers:

0546T

For the following services, preauthorization is recommended for commercial products for professional and institutional providers:

0550T   J9356   Q5112   Q5113   Q5114   Q5115   C9049   C9050   C9052

The following services are not separately reimbursed for professional and institutional providers for BlueCHiP for Medicare and commercial products:

0559T   0560T   0561T   0562T    C9756

The following service is not medically necessary for commercial products for professional and institutional providers:

0551T