Non-covered codes for Medicaid Managed Care (MMC) providers
Effective December 1, 2019, Empire BlueCross BlueShield HealthPlus began denying claims billed with non-covered codes. CPT® and HCPCS codes not included in the current New York State fee schedules are considered non-covered. Covered codes are available at https://www.emedny.org.
Non-covered codes should be billed with a more appropriate code or bundled — not separately reimbursed) with another covered code. Please note this policy notification is specific to the MMC and Child Health Plus programs only.
To avoid denials, please ensure that you are billing with the most current applicable CPT codes and HCPCS codes on the current New York State fee schedules.
List of Non-Covered CPT HCPCS Codes can be found at the following hyperlink: https://mediproviders.empireblue.com/ProviderUpdates/NYNY_CAID_PU_NoncoveredCPTHCPCSCodes.pdf.
If you have questions about this communication, please contact your Provider Relations Representative or the Provider Services team at 1-800-450-8753.
February 2020 Empire Provider News