We have completed our review of the July 2018 current procedural terminology (CPT) and HCPCS code changes
including any category II performance measurement tracking codes and category III temporary codes for emerging
technology. These updates will be added to our claims processing system and became effective July 1, 2018. The lists
include 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, CPT or HCPCS code.
• “Medicare Lab Network” – Codes that are reimbursed to a hospital laboratory outside of the laboratory network, physician 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.

October 2018 CPT Code updates

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

October 2018 HCPCS updates

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

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

*CPT is a registered trademark of the American Medical Association.