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Jan 1, 2022

CPT code changes

We have completed our review of the January 2022 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 January 1, 2022. 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:

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.

 

January 2022 CPT updates             

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

The following codes are not covered for Professional and Institutional providers for Medicare Advantage Plans and not medically necessary for Professional and Institutional providers for Commercial products:

43497       64628       64629       81560       0693T       0702T       0703T

 

The following codes are not medically necessary for Professional and Institutional providers for

Commercial products:

0676T       0678T       0690T       0701T     0709T        

                                       

The following codes are not separately reimbursed for Institutional providers for Medicare Advantage Plans and Commercial products:

01937       01938       01937       01938       01939       01940       01941       01942

 

The following codes are not separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial products: 

0699T      77090       77091       77092       93319       98975       98976       98977       98978       98980

98981      99424       99425      99426        99427       99437      

 

The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial products:

64584       69726       69727       81349       81523       93593       93594       93595       93596       93597       0679T       0682T       0697T       0698T       0710T       0711T       0712T       0713T

 

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:

68841       0672T       0673T       0674T       0675T       0677T       0680T        0681T       0683T        0684T       0685T       0686T       0689T       0691T       0692T       0694T       0695T        0696T       0700T       0707T       0708T       0285U      0286U      0287U       0288U      0289U       0290U        0291U       0292U      0293U       0294U       0295U     0296U      0297U       0298U       0299U      0300U        0303U       0304U      0305U     

 

The following codes are subject to medical review for Professional and Institutional providers for Commercial products:

33267          33269

 

The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and are not covered for Commercial products:

0687T       0688T       0704T       0705T       0706T