We have completed our review of the additional CPT and HCPCS code changes for July 2020. These updates will be added to our claims processing system and are effective July 1, 2020. The list includes 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

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 2020 CPT code updates           

The following codes are subject to medical review for Professional and Institutional providers for BlueCHiP for Medicare and not medically necessary for Professional and Institutional providers for Commercial products:

0594T       0596T       0597T       0598T       0599T       0600T       0601T       0602T       0603T       0604T

0605T       0606T       0607T       0608T       0609T       0610T       0611T       0612T       0613T       0614T

0615T       0616T       0617T       0618T       0619T       0172U       0173U      0174U      0175U      0176U

0177U       0178U      0179U      0180U      0181U       0182U      0183U       0184U      0185U      0186U           

0187U      0188U      0189U      0190U      0191U      0192U      0193U      0194U      0195U      0196U           

0197U      0198U      0199U      0200U      0201U