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.

Additional 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:

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

Q5119    Q5120    Q5121

The following codes are subject to medical review for professional and institutional providers for BlueCHiP for Medicare only:

J1558

The following codes are subject to medical review for professional and institutional providers for commercial products only:

C9061  C9063  J0223   J0791   J0896   J3399   J9177   J9198   J9246   J935

The following code is not covered for professional and institutional providers for BlueCHiP for Medicare and subject to medical review for professional and institutional providers for commercial products:

J1429

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

C9122

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

J7333

The following code is not covered for professional and institutional providers for BlueCHiP for Medicare and commercial products:

J0591