Summary
Blue Cross Blue Shield of Rhode Island updated CPT/HCPCS code coverage rules effective July 1, 2020. Multiple codes now require prior authorization, are not covered, or are deemed not medically necessary, with different rules for commercial vs. BlueCHiP Medicare products.
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What to do
immediately · 4 steps
01Billing team must update system settings for affected BCBS Rhode Island claims.
02Configure prior authorization requirements for codes Q5119, Q5120, Q5121, J1558, C9061, C9063, J0223, J0791, J0896, J3399, J9177, J9198, J9246, J935, and J1429 based on plan type.
03Mark codes J0591, C9122, and J7333 as non-covered/not medically necessary.
04Update encounter forms to alert providers about non-covered services that must be disclosed to patients before rendering care.
Codes mentioned
Q5119Q5120Q5121J1558C9061C9063J0223J0791J0896J3399J9177J9198J9246J935J1429C9122J7333J0591
Original notice
CPT code changes
bcbsri.com · Always check the source before changing claims.
Related changes
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