This has resulted in the following changes for services provided on or after January 1, Prior Approval New and Revised Codes
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1 November 30, 2012 Dear Provider: Blue Cross and Blue Shield of Vermont (BCBSVT) completed our review of the Current Procedural Terminology (CPT) and Health Care Procedure Coding System (HCPCS) additions, deletions and revisions for We also completed our annual review of services requiring prior approval. This has resulted in the following changes for services provided on or after January 1, Prior Approval New and Revised Codes The following new 2013 CPT/HCPCS codes require prior approval, or for New England Health Plan members, a referral authorization: New 2013 codes (grid reads left to right): T 0292T 0293T 0294T 0295T 0296T 0297T 0298T 0299T 0300T 0301T 0302T 0303T 0304T 0305T 0306T 0307T 0308T 0309T 0310T 0311T 0312T 0313T 0314T 0315T 0316T 0317T 0318T 0319T 0320T 0321T 0322T 0323T 0324T 0325T 0326T 0327T 0328T A4435* E0670* E2378* G0452 L7902* *prior approval is required only if purchase or rental price is greater than $500.00
2 Page 2 November 30, 2012 The following revised 2013 CPT/HCPCS codes will (or will continue) to require prior approval, or for New England Health Plan members, a referral authorization: Revised 2013 codes (grid reads left to right): Removal of Prior Approval Requirements for 2013 BCBSVT completed our review of the existing prior approval list. The review has resulted in a reduction of services that will require prior approval in We will require prior approval for orthotics and prosthetics if the line item will have a rental or purchase price greater than $ Otherwise, prior approval is not required. The following medical services no longer require prior approval: Procedure CPT or HCPCS code(s) Continuous Glucose Monitoring (Outpatient 72 hours) 95250, Endocrinology 95250, Glucose Monitoring (Continuous or Intermittent) in 95250, Interstitial Fluid (CGMS) Home Infusion Therapy NOTE: Home Infusion Therapy Drugs will continue to require prior approval through Express Scripts, Inc. Hospice Care Oral Appliances for Obstructive Sleep Apnea 21076, 70350, Private Duty Nursing S9123, S9124 Rehabilitation (cardiac/pulmonary) Cardiac Rehab, Outpatient Phase II Pulmonary Rehab NOTE: Inpatient cardiac rehab will continue to require prior approval , S9472, G0422, G0423 S9473, G0237, G0238, G0302, G0303, G0304, G0305, G0424, G0239
3 Page 3 Surgery: Collis Gastroplasty NOTE: other surgeries noted on the PA list will continue to require prior approval. Transplant, Cornea T, 0290T NOTE: Transplant and related services (except kidney and cornea) will continue to require prior approval. Wound Care Management 97605, 97606, A6550, A9272, E2402 The following durable medical equipment/supplies no longer require prior approval: Procedure External Insulin Pump Glucose Monitoring (Continuous or Intermittent) in interstitial fluid (CGMS) High Frequency Chest Well Oscillation System and Supplies Insulin Pump and Supplies Nebulizers Oral Appliance for Obstructive Sleep Apnea CPT or HCPCS code(s) A4230, A4231, A4232, A9274, E0784, S9145 A9276, A9277, A9278, S1030, S1031, 95250, A7025, A7026 A9274, A9279 E0570-E0585 E0486, 21076, 70350, The complete, updated prior approval and referral authorization reference guides are available on the provider website at
4 Page 4 Unit Designation Changes The following CPT/HCPCS designations will change as noted: CPT/ HCPC Codes Modifier Previous Units Designation S= Single M = Multiple CHANGE Current Designation (Indicate S or M) S = Single M = Multiple 0235T S M 0236T M S S M M S M S S M S M S M M S M S M S M S M S A4398 S M A4481 S M C1730 S M C1769 S M C1781 S M C1874 S M C1887 S M C1893 S M C1894 S M E1020 S M E2368 M S E2369 M S E2370 M S L8000 M S S0020 S M
5 Page 4 Services billed for dates of service January 1, 2013 or after require the correct billing of unit designation. Our provider website provides an overview of changes from October 2008 to January 1, You can access the complete grid of these changes under Tools & Resources. Visit to view this information. Please note we base unit designation changes upon date of service. Thank you for your time. If you have any questions, please feel free to contact your provider relations consultant. You can reach us by phone at (888) You may also reach us through at Our business hours are Monday through Friday, 8 a.m. 4:30 p.m. Sincerely, Cynthia E. Horan Director, Provider Relations
Behavioral Health. Mental Health, Alcohol & Chemical Dependency. Medicare & Medicaid
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Dear Provider: This notice contains information you should be aware of related to: New and revised Medical and Payment Policies October 1, 2016 CPT/HCPCS impacts Services that will require prior approval
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