We have completed our review of the July 2024 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 July 1, 2024. 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.
July 2024 CPT updates
Please note: Coverage and/or payment rules for code(s) below may be subject to change for Medicare Advantage Plans and/or Commercial Products.
Additionally, coverage may vary for those Commercial Products that have opted out of the Biomarker Testing Mandate.
The following code(s) are covered and separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:
90637 90638 90684 0464U 0889T 0890T 0891T 0892T
The following code(s) are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and are not medically necessary for Commercial Products:
0867T 0868T 0869T 0870T 0871T 0872T 0873T 0875T 0877T 0878T 0879T 0880T
0881T 0882T 0883T 0884T 0885T 0886T 0887T 0888T 0897T 0898T
The following code(s) are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:
0450U 0451U 0452U 0453U 0455U 0456U 0457U 0458U 0459U 0460U 0461U 0462U 0463U
0465U 0466U 0467U 0468U 0469U 0470U 0471U 0472U 0473U 0474U 0475U 0020M
0874T 0876T 0899T 0900T
The following code(s) are covered when filed with ICD-10-CM range F01-F99, all other ICD-10-CM’s are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:
0454U
The following code(s) are not separately reimbursed for Professional providers only for Medicare Advantage Plans and for Commercial Products:
0882T 0883T
The following code(s) are not separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and for Commercial Products:
0877T 0878T 0879T 0880T 0881T 0887T 0893T 0894T 0895T 0896T 0897T 0898T