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Blue Cross Blue Shield of Rhode IslandCommercial · Billing Codes · Provider Update · RI · OB-GYN, Radiology, Ophthalmology +3 moreMedium impact

August 2017

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Already effective August 1, 2017, CPT codes 0006U through 0017U carry coverage designations for BlueCHiP for Medicare and commercial products, including not covered, not medically necessary and subject to medical review. Already effective July 1, 2017, the brand drug Makena still needs preauthorization and must be filed with HCPCS Q9986, and HCPCS J1725 should not be used for hydroxyprogesterone caproate medications because claims filed with it deny as use alternate code. Already effective September 1, 2017, BCBSRI requires the name and Type 1 NPI of the ordering provider on CMS-1500 claims or electronic submissions for laboratory, imaging, durable medical equipment and home infusion services.

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What to do

Action · 9 steps
01Already effective July 1, 2017: File claims for the brand drug Makena with HCPCS Q9986, since it continues to need preauthorization, and do not use HCPCS J1725 for any hydroxyprogesterone caproate medication.
02Already effective August 1, 2017: As a participating provider, notify members about non-covered services before rendering them.
03For codes marked subject to medical review, obtain preauthorization, which is recommended for commercial products and required for BlueCHiP for Medicare.
04Already effective January 1, 2017: Commercial claims for G0202, G0204 and G0206 are covered and separately reimbursed, and claims previously denied as use alternate code will be adjusted to be paid.
05Already effective for services performed on or after May 25, 2017: For BlueCHiP for Medicare members, supervised exercise therapy for intermittent claudication is covered when rendered as part of a SET program, and it remains not medically necessary for commercial members.
06Already effective September 1, 2017: Providers must report the ordering provider's name in CMS-1500 box 17 and the Type 1 NPI in box 17b, or in the 2310A Loop, NM109 segment for electronic submitters, because missing or incomplete information results in the claim being rejected back to the provider.
07Already effective November 1, 2017: The ophthalmology examinations and refractions coding policy was updated to reflect claims filing requirements, so review the full policy text.
08Submit CPT Category II code 1111F when medication reconciliation is performed.
09Check current applicability before acting on these 2017 items.

Codes mentioned

J1725Q9986G0202G0204G0206

Original notice

August 2017
bcbsri.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
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Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesOB-GYNRadiologyOphthalmologyNeurologyCardiologyPharmacyCode J1725Code Q9986Code G0202Code G0204Code G0206

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