1/1/2020 CPT & HCPCS Annual Code Update Coverage Determinations for Medicare Advantage Products



    Purpose

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

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

    Coverage Statement

    As a result of the Annual 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 1/1/2020.

    Coding

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

    ELIGIBLE SERVICES

    0154U

    0155U

    0573T

    0580T

    0584T

    0585T

    0586T

    0588T

    15769

    15771

    15772

    15773

    15774

    20560

    20561

    20700

    20701

    20702

    20703

    20704

    20705

    21601

    21602

    21603

    33016

    33017

    33018

    33019

    33858

    33859

    33871

    34717

    34718

    35702

    35703

    49013

    49014

    62328

    62329

    64451

    74221

    74248

    78429

    78430

    78431

    78432

    78433

    78434

    78830

    78831

    78832

    78835

    81277

    81307

    81308

    81309

    81522

    81542

    81552

    87563

    90694

    90912

    90913

    92201

    92202

    93985

    93986

    95700

    95705

    95706

    95707

    95708

    95709

    95710

    95711

    95712

    95713

    95714

    95715

    95716

    95717

    95718

    95719

    95720

    95721

    95722

    95723

    95724

    95725

    95726

    96156

    96158

    96159

    96164

    96165

    96167

    96168

    96170

    96171

    97129

    97130

    99458

    99473

    99474

    A4226

    A9590

    B4187

    C9054

    C9055

    C9757

    C9758

    E0787

    E2398

    G2066

    G2067

    G2068

    G2069

    G2070

    G2071

    G2072

    G2073

    G2074

    G2075

    G2076

    G2077

    G2078

    G2079

    G2080

    G2082

    G2083

    G2086

    G2087

    G2088

    J0179

    J9199

    J9309

    K1005

    P9099

    NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

    G2058

    G2064

    G2065

    NOT ELIGIBLE FOR REIMBURSEMENT

    0591T

    0592T

    0593T

    NON-COVERED

    98970

    98971

    98972

    99421

    99422

    99423

    G2061

    G2062

    G2063

    K1003

    L8033

    EXPERIMENTAL/INVESTIGATIONAL

    0139U

    0140U

    0141U

    0142U

    0143U

    0144U

    0145U

    0146U

    0147U

    0148U

    0149U

    0150U

    0151U

    0152U

    0153U

    0156U

    0157U

    0158U

    0159U

    0160U

    0161U

    0162U

    0563T

    0564T

    0565T

    0566T

    0567T

    0568T

    0569T

    0570T

    0571T

    0572T

    0574T

    0575T

    0576T

    0577T

    0578T

    0579T

    0581T

    0582T

    0583T

    0587T

    0589T

    0590T

    46948

    64454

    64624

    64625

    80145

    80187

    80230

    80235

    80280

    80285

    92549

    93356

    C1734

    C1824

    C1839

    C1982

    C2596

    K1001

    K1002

    K1004

    L2006


    Issued on - 12/27/2019


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