4/1/2020 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products (revised 05/04/2020)




    Purpose

    The intent of this news article is to communicate Commercial Product coverage determinations for services identified through the Quarterly Code Update process. The procedure codes that represent these services will become effective on 4/1/2020.

    For more information related to these services, refer to specific policies when applicable.


    Coverage Statement

    As a result of the Quarterly Code Update process, the following services have been reviewed, and coverage determinations made by the Company are identified below. The procedure codes that represent these services will be effective on 4/1/2020.


    Coding

    Inclusion of a code in this article does not imply reimbursement. Medical Necessity, eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

    ELIGIBLE SERVICES

    0168U

    * 86328

    * 86769

    * 87635

    C9053

    C9056

    C9057

    C9058

    * G2023

    * G2024

    * U0001

    * U0002

    * U0003

    * U0004

    * Codes 86328, 86769 are effective 4/10/2020. Code 87635 is effective 3/13/2020. Codes G2023, G2024 are effective 3/1/2020. Codes U0001, U0002 are effective 2/4/2020. Codes U0003, U0004 are effective 4/14/2020.


    NOT MEDICALLY NECESSARY

    G2168

    G2169


    NOT ELIGIBLE FOR REIMBURSEMENT

    G1012

    G1013

    G1014

    G1015

    G1016

    G1017

    G1018

    G1019



    EXPERIMENTAL/INVESTIGATIONAL SERVICES

    0014M

    0163U

    0164U

    0165U

    0166U

    0167U

    0169U

    0170U

    0171U


    Issued on - 04/01/2020