AdministrativeCommercialMay 1, 2023

Updates to standard facility code groups for CTs, MRIs, Mammograms *

*Notice of Material Amendment to Contract and/or Change to Prior Authorization Requirements

As part of ongoing review and maintenance of CPT® code changes, we have identified codes in our CT/MRI/Mammogram standard code set that need to be added and or deleted due to annual maintenance. These code sets will be updated effective August 1, 2023.

Reimbursement for these codes will be made according to the terms of the provider agreement. If you have questions, please reach out to your Provider Relationship Account Manager.

Mammogram:

Codes to be removed

77061 – 77062

DIGITAL BREAST TOMOSYNTHESESIS; UNILATERAL/DIGITAL BREAST TOMOSYNTHESESIS; BILATERAL

Code to be added

G0279

(DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)

CT:

Codes to be removed

0042T

(CEREBRAL PERFUSION ANALYSIS USING COMPUTED TOMOGRAPHY W/CONT ADMIN INCL POST PROC OF PARAMETRIC MAPS W/DETER OF CEREBRAL)

Codes to be added

S8092

ELECTRON BEAM COMPUTED TOMOGRAPHY (ALSO KNOWN AS ULTRAFAST CT, CINE CT)

0558T

COMPUTED TOMOGRAPHY SCAN TAKEN FOR THE PURPOSE OF BIOMECHANICAL COMPUTED TOMOGRAPHY ANALYSIS

0633T – 0638T

COMPUTED TOMOGRAPHY, BREAST, INCLUDING 3D RENDERING, WHEN PERFORMED, UNILATERAL; WITHOUT CONTRAST MATERIAL

0721T

QUANTITATIVE COMPUTED TOMOGRAPHY (CT) TISSUE CHARACTERIZATION, INCLUDING INTERPRETATION AND REPORT

Going forward, any code added within the following code ranges will automatically be added to the CT category:

70450 – 70498

71250 – 71275

72125 – 72133

72191 – 72194

73200 – 73206

73700 – 73706

74150 – 74178

74261 – 74263

75571 – 75574

0633T – 0638T

MRI:

Code to be added

76391

MAGNETIC RESONANCE (EG, VIBRATION) ELASTOGRAPHY

S8035

MAGNETIC SOURCE IMAGING

S8037

MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY

0648T

QUANTITATIVE MAGNETIC RESONANCE FOR ANALYSIS OF TISSUE COMPOSITION (for example, FAT, IRON, WATER CONTENT), INCLUDING MULTIPARAME)

0640T – 0642T

NONCONTACT NEAR-INFRARED SPECTROSCOPY STUDIES OF FLAP OR WOUND; IMAGE ACQUISITION, INTERPRETATION AND REPORT, EACH FLAP

0697T

QUANTITATIVE MAGNETIC RESONANCE FOR ANALYSIS OF TISSUE, INCLD MULTIPARAMETRIC, DURING THE SAME SESSION; MULTIPLE ORGAN)

0723T

QUANTITATIVE MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (QMRCP), DATA, INTERPRETATION AND REPORT, WITHOUT MRI EXAM

Going forward, any code added within the following code ranges will automatically be added to the MRI category:

70540 – 70559

71550 – 71555

72141 – 72159

73218 – 73225

73718 – 73725

74181 – 74185

75557 – 75563

 

OHBCBS-CM-022302-23

PUBLICATIONS: May 2023 Provider News