0159T and 0190T codes require clinical review for BCN members even when used as add-on codes

Services associated with procedure codes *0159T and *0190T require clinical review by Blue Care Network even though they are add-on codes. These changes apply to both BCN HMO^SM (commercial) and BCN Advantage^SM members.

We had communicated earlier that these codes were among several that no longer required clinical review through eviCore healthcare when used as an add-on codes, as long as a valid authorization is on file for the primary code.

However, because the *0159T and *0190T codes represent services that are experimental and investigational, they do require clinical review by BCN on their own merits even when they are used as an add-on code and a valid authorization is on file for the primary code. This is effective immediately.

Claims will deny when they show one of these codes used as an add-on code and a valid authorization is not on file for both the primary and the add-on code.

* CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.

Posted: March 2016
Line of business: Blue Care Network