May 1, 2024

Payment Policy Updates

G2211 will be considered NSR effective July 1, 2024

Effective July 1, 2024, CPT G2211 code will be NSR for both commercial and Medicare Advantage for professional. This code was made active by CMS as of January 1, 2024 to make G2211 separately payable as an additional payment to the payment of Office/Outpatient E/M visit (new patient CPT codes 99202-99205, established patient CPT Codes 99211-99215). CMS believes that the valuations for office visit codes do not adequately reflect the cost of caring for the complexity of certain kinds of visits. For additional information related this this policy, please click here.

COVID-19 Diagnostic Testing After PHE End Date

The details in the policy were expanded upon to clarify coverage. For Medicare ONLY effective January 1, 2024, COVID at-home test kits with a physician’s order are not a covered medical benefit. COVID at-home test kits will continue to be covered as part of the supplemental benefit over the counter (OTC). As a reminder, for commercial, we cover COVID-19 OTC tests with an MD order for commercial coverage. For additional information related this this policy, please click here.

Preventive Services for Commercial Members

HCPCS K1005 (breast milk storage bags) terminated on December 31, 2023 and was replaced with permanent code A4287 effective January 1, 2024  For additional information related this this policy, please click here.

Non-Reimbursable Health Service Code Policy

HCPCS code A4455 was updated to show NSR for A4455 for Medicare facilities. For additional information related this this policy, please click here.

Telemedicine/Telephone Services for Commercial Products and Medicare Advantage Plans

HCPCS code H0038 was added to the policy for both commercial and Medicare products allowing this code to be billed with place of service 02 and 10. For additional information related this this policy, please click here.


Physical and Occupational Services 

Effective July 1, 2024, BCBSRI will require the use of PTA and OTA modifiers CQ and CO when services are provided in whole or part by a PTA or an OTA. The use of the modifiers will follow CMS guidelines; however, for BCBSRI the modifiers will be informational only and there will be no impact to BCBSRI’s current reimbursement rates as the result of requiring the modifier. 

COVID-19 Monoclonal Antibody Treatment and Antiviral IV Medications

On March 22, 2024, the FDA released an emergency use authorization for the PEMGARDA (pemivibart) investigational monoclonal antibody product for pre-exposure prophylaxis of COVID-19 in certain adults and adolescents. Per CMS guidelines , two new HCPCS codes Product code Q0224 and Administration code M0224 will be effective March 22, 2024. 

2024 Preventative Services for Commercial Members and 2024 Preventative Services for Medicare Advantage Plans

A new product for colorectal screening is Colosense Plus® HCPCS code 0646U will be effective July 1, 2024. This code has been added to both Commercial and Medicare Preventative Payment Policies.

2024 Chiropractic Services

Effective in 2020, Medicare required AT modifier for CMT. At the AT modifier requirement will now be outlined in the policy. Effective July 1, 2024, the AT modifier will be required per CMS guidelines.