We have completed our review of one additional new Healthcare Common Procedure Coding System (HCPCS) code. This update will be added to our claims processing system and is effective July 6, 2023. The list includes this code, which has special coverage or payment rules for standard Products. (Some employers may customize their benefits.) We have included this HCPCS code for a service that is:

• “Subject to medical review” – preauthorization is recommended for Commercial Products and required for Medicare Advantage Plans.

Please submit your comments and concerns regarding coverage and payment designations to:

Blue Cross & Blue Shield of Rhode Island

Attention: Medical Policy, HCPCS 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.

July 6, 2023 HCPCS Update:

Please note: Coverage and/or payment rules for code(s) below may be subject to change for Medicare Advantage Plans and/or Commercial Products.

The following code is subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:

J0174