CPT code changes
We have completed our review of the October 2021 CPT code changes, including any Category II performance measurement tracking codes and Category II temporary codes for emerging technology. These updates will be added to our claims processing system and are effective October 1, 2021. 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 it.
- “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:
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 2021 HCPCS code updates
The following codes are subject to medical review for professional and institutional providers for Medicare Advantage plans and are not medically necessary for commercial products:
0255U 0256U 0257U 0258U 0259U 0260U 0261U 0262U 0263U 0264U 0265U 0266U 0267U 0268U 0269U 0270U 0271U 0272U 0273U 0274U 0275U 0276U 0277U 0278U 0279U 0280U 0281U 0282U 0283U 0284U 0018M