Summary
Blue Cross Blue Shield of Rhode Island updated CPT and HCPCS code coverage and payment rules effective April 1, 2021. Specific codes now have new designations including medical review requirements, non-coverage determinations, and separate reimbursement restrictions.
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What to do
immediately · 5 steps
01Update billing system coverage rules for the specified HCPCS codes.
02Set codes C9074, J1554, J9037, J9349, Q2053 to require preauthorization for commercial products and BlueCHiP Medicare.
03Mark codes C9777, J1427, J7402, K1013, K1016, K1017, K1018, K1019, K1020, S1091 as non-covered/not medically necessary.
04Configure codes G2211, A9592, C9776, K1014, K1015 as non-separately reimbursable.
05Train staff to notify members of non-covered services before providing them.
Codes mentioned
C9074J1554J9037J9349Q2053C9777J1427J7402K1013K1016K1017K1018K1019K1020S1091G2211A9592C9776K1014K1015
Original notice
CPT code changes
bcbsri.com · Always check the source before changing claims.
Related changes
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