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

Email: Medical.Policy@bcbsri.org

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.

October 2019 CPT  Code Updates  PF

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

0105U    0106U    0107U    0108U    0109U    0110U    0111U    0112U    0114U    0115U    0116U    0117U    0118U    0119U    0120U    0121U    0122U 0123U    0124U    0125U   0126U    0127U    0128U    0129U    0130U    0131U    0132U    0133U    0134U    0135U    0136U    0137U    0138U       

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

0113U

October 2019 HCPCS Code Updates         

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

J3111  J9119  J9204  J9210  J9269

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

J0222  J1303  J9118  J9313  Q5116 Q5117 Q5118

The following service is not covered for professional and institutional providers for BlueCHiP for Medicare and not medically necessary for Commercial products for professional and Institutional providers:

J7401

The following service is not covered for professional and institutional providers for BlueCHiP for Medicare and Commercial products:

J0593  J3031

The following service is not covered for professional and institutional providers for Commercial Products:

J7331  J7332