Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA00.026g


Attachment:A

Policy #:MA00.026g

Description:CPT Codes and HCPCS Codes

Title:Always Bundled Procedure Codes


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

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.



CPT Codes and HCPCS Codes

Code
0537T
0538T
0539T
15850
20930
20936
22841
34839
36416
38204
90885
90887
90889
92352
92353
92354
92355
92358
92371
92531
92532
92533
92534
92605
92606
92618
92921
92925
92929
92934
92938
92944
93740
93770
94005
94150
96902
97010
97602
98960
98961
98962
99000
99001
99002
99024
99050
99051
99053
99056
99058
99060
99070
99071
99078
99080
99100
99116
99135
99140
99288
99339
99340
99360
99366
99367
99368
99374
99377
99379
99380
99485
99486
A4262
A4263
A4270
A4300
A4550
G0175
G0269
G0501
Q3031
R0076
S0220
S0221
S8030



Version Effective Date: 01/01/2020
Version Issued Date: 12/31/2019
Version Reissued Date: N/A

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.