2020 reimbursement changes/updates · 2020. 8. 4. · 2020 reimbursement changes/updates page 2 of...

2020 Reimbursement Changes/Updates

This schedule is not a guaranty of payment. Variances in reimbursement may occur due to rounding calculations. Services represented are subject to provisions of the health plan including, but not limited to, membership eligibility, premium payment, claim payment logic, provider contract terms and conditions, applicable medical policy and benefits, limitations and exclusions. Maximum allowable and components of rates such as modifiers or conversion factors, and applicable rules such as bundling, may change from time to time subject to notice requirements of applicable law and regulation and the prevailing provider agreement. Values reflect the component of a code related to the place of treatment. CPT codes are copyright American Medical Association. All Rights Reserved. BCBSTX - HCSC Confidential and Proprietary.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

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Other Codes Update

(Posted 8/4/20)

Procedure Modifier Maximum Allowable

Effective Date

End Date

99001 $4.66 3/1/20 7/31/20

99001 $23.46 8/1/20 99001 26 $4.66 3/1/20 7/31/20

99001 26 $23.46 8/1/20 99001 TC $4.66 3/1/20 7/31/20

99001 TC $23.46 8/1/20

NDC Monthly Drug Update - Effective 11/1/20 (Posted 8/1/20)

Procedure Maximum Allowable Effective Date End

Date

Refer to the NDC Drug Schedule for procedure codes, NDC and pricing changes for the Monthly NDC Drug Update effective 11/1/20.

Other Codes Update

(Posted 7/17/20)


Effective Date

End Date

A0425 $16.09 3/1/20 7/14/20

A0425 $16.79 7/15/20

A0426 $573.88 3/1/20 7/14/20

A0426 $599.14 7/15/20

A0427 $908.64 3/1/20 7/14/20

A0427 $948.62 7/15/20

A0428 $478.23 3/1/20 7/14/20

A0428 $499.27 7/15/20

A0429 $765.17 3/1/20 7/14/20

A0429 $798.84 7/15/20

A0430 $14,193.52 3/1/20 7/14/20

A0430 $17,063.96 7/15/20

A0431 $16,502.11 3/1/20 7/14/20

A0431 $19,839.44 7/15/20

A0432 $836.90 3/1/20 7/14/20

A0432 $873.73 7/15/20

A0433 $1,315.13 3/1/20 7/14/20

A0433 $1,373.00 7/15/20

A0434 $1,554.23 3/1/20 7/14/20

A0434 $1,622.63 7/15/20

A0435 $41.57 3/1/20 7/14/20

A0435 $49.97 7/15/20


of 23

Other Codes Update

(Posted 7/17/20)


Effective Date

End Date

A0436 $110.90 3/1/20 7/14/20

A0436 $133.32 7/15/20

NDC Codes Update (Posted 7/17/20)

Procedure NDC Allowable Effective Date

End Date

J3399 71894012002 $2125000.00 10/1/20 10/1/20

J3399 71894012002 $2162145.00 10/1/20 10/31/20

J3399 71894012103 $2125000.00 10/1/20 10/1/20

J3399 71894012103 $2162145.00 10/1/20 10/31/20

J3399 71894012203 $2125000.00 10/1/20 10/1/20

J3399 71894012203 $2162145.00 10/1/20 10/31/20

J3399 71894012303 $2125000.00 10/1/20 10/1/20

J3399 71894012303 $2162145.00 10/1/20 10/31/20

J3399 71894012404 $2125000.00 10/1/20 10/1/20

J3399 71894012404 $2162145.00 10/1/20 10/31/20

J3399 71894012504 $2125000.00 10/1/20 10/1/20

J3399 71894012504 $2162145.00 10/1/20 10/31/20

J3399 71894012604 $2125000.00 10/1/20 10/1/20

J3399 71894012604 $2162145.00 10/1/20 10/31/20

J3399 71894012705 $2125000.00 10/1/20 10/1/20

J3399 71894012705 $2162145.00 10/1/20 10/31/20

J3399 71894012805 $2125000.00 10/1/20 10/1/20

J3399 71894012805 $2162145.00 10/1/20 10/31/20

J3399 71894012905 $2125000.00 10/1/20 10/1/20

J3399 71894012905 $2162145.00 10/1/20 10/31/20

J3399 71894013006 $2125000.00 10/1/20 10/1/20

J3399 71894013006 $2162145.00 10/1/20 10/31/20

J3399 71894013106 $2125000.00 10/1/20 10/1/20

J3399 71894013106 $2162145.00 10/1/20 10/31/20

J3399 71894013206 $2125000.00 10/1/20 10/1/20

J3399 71894013206 $2162145.00 10/1/20 10/31/20

J3399 71894013307 $2125000.00 10/1/20 10/1/20

J3399 71894013307 $2162145.00 10/1/20 10/31/20

J3399 71894013407 $2125000.00 10/1/20 10/1/20

J3399 71894013407 $2162145.00 10/1/20 10/31/20

J3399 71894013507 $2125000.00 10/1/20 10/1/20

J3399 71894013507 $2162145.00 10/1/20 10/31/20

J3399 71894013608 $2125000.00 10/1/20 10/1/20

J3399 71894013608 $2162145.00 10/1/20 10/31/20

J3399 71894013708 $2125000.00 10/1/20 10/1/20

J3399 71894013708 $2162145.00 10/1/20 10/31/20

J3399 71894013808 $2125000.00 10/1/20 10/1/20

J3399 71894013808 $2162145.00 10/1/20 10/31/20

J3399 71894013909 $2125000.00 10/1/20 10/1/20

J3399 71894013909 $2162145.00 10/1/20 10/31/20

J3399 71894014009 $2125000.00 10/1/20 10/1/20

J3399 71894014009 $2162145.00 10/1/20 10/31/20

J3399 71894014109 $2125000.00 10/1/20 10/1/20

J3399 71894014109 $2162145.00 10/1/20 10/31/20


of 23



Date


Other Codes Update

(Posted 6/12/20)


Effective Date

End Date

86328 $18.09 4/10/20 5/18/20

86328 $45.23 5/19/20 86328 26 $18.09 4/10/20 5/18/20

86328 26 $45.23 5/19/20 86328 TC $18.09 4/10/20 5/18/20

86328 TC $45.23 5/19/20 86769 $12.88 4/10/20 5/18/20

86769 $42.13 5/19/20 86769 26 $12.88 4/10/20 5/18/20

86769 26 $42.13 5/19/20 86769 TC $12.88 4/10/20 5/18/20

86769 TC $42.13 5/19/20

Other Codes Update

(Posted 6/3/20)


Effective Date

End Date

U0002 $51.33 3/12/20 9/2/20

U0002 $51.31 9/3/20 87635 $51.33 3/13/20 9/2/20

87635 $51.31 9/3/20



End Date

C9058 61314086601 $6346.2735 9/1/20 9/1/20

Quarterly Drug Update - Effective 9/1/20 (Posted 6/1/20)


Date

Refer to the Drug Schedule for procedure codes and pricing changes for the Quarterly Drug Update effective 9/1/20.


of 23



Date




End Date

90378 60574411301 $712.964 8/1/20 8/1/20

90378 60574411301 $2851.856 8/1/20 8/31/20

90378 60574411401 $755.144 8/1/20 8/1/20

90378 60574411401 $3020.576 8/1/20 8/31/20

90585 00052060301 $33.73792 8/1/20 8/1/20

90585 00052060301 $108.56448 8/1/20 8/31/20

90585 00052060302 $33.73792 8/1/20 8/1/20

90585 00052060302 $108.56448 8/1/20 8/31/20

90586 00052060201 $36.37664 8/1/20 8/1/20

90586 00052060201 $152.10336 8/1/20 8/31/20

90586 00052060202 $36.37664 8/1/20 8/1/20

90586 00052060202 $152.10336 8/1/20 8/31/20

J0129 00003218811 $264.57215 8/1/20 8/1/20

J0129 00003218811 $1127.91285 8/1/20 8/31/20

J0129 00003218851 $264.57215 8/1/20 8/1/20

J0129 00003218851 $1127.91285 8/1/20 8/31/20

J0278 00703903203 $2.9412 8/1/20 8/1/20

J0278 00703903203 $4.4118 8/1/20 8/31/20

J0278 23155029041 $2.9412 8/1/20 8/1/20

J0278 23155029041 $4.4118 8/1/20 8/31/20

J0278 63323081502 $2.796 8/1/20 8/1/20

J0278 63323081502 $4.194 8/1/20 8/31/20

J0401 59148001870 $337.7979 8/1/20 8/1/20

J0401 59148001870 $1706.05 8/1/20 8/31/20

J0401 59148001871 $337.7979 8/1/20 8/1/20

J0401 59148001871 $1706.05 8/1/20 8/31/20

J0401 59148001970 $450.3972 8/1/20 8/1/20

J0401 59148001970 $2274.73 8/1/20 8/31/20

J0401 59148001971 $464.0456 8/1/20 8/1/20

J0401 59148001971 $2265.6344 8/1/20 8/31/20

J0401 59148004580 $337.7979 8/1/20 8/1/20

J0401 59148004580 $1706.05 8/1/20 8/31/20

J0401 59148007280 $450.3972 8/1/20 8/1/20

J0401 59148007280 $2274.73 8/1/20 8/31/20

J0561 60793070110 $17.560116 8/1/20 8/1/20

J0561 60793070110 $85.734684 8/1/20 8/31/20

J0561 60793070210 $17.99178 8/1/20 8/1/20

J0561 60793070210 $87.84222 8/1/20 8/31/20

J0713 25021012720 $0.9984 8/1/20 8/1/20

J0713 25021012720 $5.2416 8/1/20 8/31/20

J0775 66887000301 $881.94015 8/1/20 8/1/20

J0775 66887000301 $4666.35 8/1/20 8/31/20

J0881 55513000201 $45.8595 8/1/20 8/1/20


of 23



End Date

J0881 55513000201 $186.3405 8/1/20 8/31/20

J0881 55513000204 $45.8595 8/1/20 8/1/20

J0881 55513000204 $186.3405 8/1/20 8/31/20

J0881 55513000301 $73.3752 8/1/20 8/1/20

J0881 55513000301 $298.1448 8/1/20 8/31/20

J0881 55513000304 $73.3752 8/1/20 8/1/20

J0881 55513000304 $298.1448 8/1/20 8/31/20

J0881 55513000401 $110.0628 8/1/20 8/1/20

J0881 55513000401 $447.2172 8/1/20 8/31/20

J0881 55513000404 $110.0628 8/1/20 8/1/20

J0881 55513000404 $447.2172 8/1/20 8/31/20

J0881 55513000501 $183.438 8/1/20 8/1/20

J0881 55513000501 $745.362 8/1/20 8/31/20

J0881 55513000504 $183.438 8/1/20 8/1/20

J0881 55513000504 $745.362 8/1/20 8/31/20

J0881 55513000601 $366.876 8/1/20 8/1/20

J0881 55513000601 $1490.724 8/1/20 8/31/20

J0881 55513002101 $183.438 8/1/20 8/1/20

J0881 55513002101 $745.362 8/1/20 8/31/20

J0881 55513002104 $183.438 8/1/20 8/1/20

J0881 55513002104 $745.362 8/1/20 8/31/20

J0881 55513002301 $366.876 8/1/20 8/1/20

J0881 55513002301 $1490.724 8/1/20 8/31/20

J0881 55513002304 $366.876 8/1/20 8/1/20

J0881 55513002304 $1490.724 8/1/20 8/31/20

J0881 55513002501 $366.876 8/1/20 8/1/20

J0881 55513002501 $1490.724 8/1/20 8/31/20

J0881 55513002504 $366.876 8/1/20 8/1/20

J0881 55513002504 $1490.724 8/1/20 8/31/20

J0881 55513002701 $917.19 8/1/20 8/1/20

J0881 55513002701 $3726.81 8/1/20 8/31/20

J0881 55513002704 $917.19 8/1/20 8/1/20

J0881 55513002704 $3726.81 8/1/20 8/31/20

J0881 55513002801 $917.19 8/1/20 8/1/20

J0881 55513002801 $3726.81 8/1/20 8/31/20

J0881 55513003201 $917.19 8/1/20 8/1/20

J0881 55513003201 $3726.81 8/1/20 8/31/20

J0881 55513005701 $109.1892851 8/1/20 8/1/20

J0881 55513005701 $443.6678548 8/1/20 8/31/20

J0881 55513005704 $109.1892851 8/1/20 8/1/20

J0881 55513005704 $443.6678548 8/1/20 8/31/20

J0881 55513009801 $45.8595 8/1/20 8/1/20

J0881 55513009801 $186.3405 8/1/20 8/31/20

J0881 55513009804 $45.8595 8/1/20 8/1/20

J0881 55513009804 $186.3405 8/1/20 8/31/20

J0881 55513011001 $550.314 8/1/20 8/1/20

J0881 55513011001 $2236.086 8/1/20 8/31/20

J0881 55513011101 $917.19 8/1/20 8/1/20

J0881 55513011101 $3726.81 8/1/20 8/31/20

J0882 55513000201 $45.8595 8/1/20 8/1/20

J0882 55513000201 $186.3405 8/1/20 8/31/20

J0882 55513000204 $45.8595 8/1/20 8/1/20

J0882 55513000204 $186.3405 8/1/20 8/31/20

J0882 55513000301 $73.3752 8/1/20 8/1/20


of 23



End Date

J0882 55513000301 $298.1448 8/1/20 8/31/20

J0882 55513000304 $73.3752 8/1/20 8/1/20

J0882 55513000304 $298.1448 8/1/20 8/31/20

J0882 55513000401 $110.0628 8/1/20 8/1/20

J0882 55513000401 $447.2172 8/1/20 8/31/20

J0882 55513000404 $110.0628 8/1/20 8/1/20

J0882 55513000404 $447.2172 8/1/20 8/31/20

J0882 55513000501 $183.438 8/1/20 8/1/20

J0882 55513000501 $745.362 8/1/20 8/31/20

J0882 55513000504 $183.438 8/1/20 8/1/20

J0882 55513000504 $745.362 8/1/20 8/31/20

J0882 55513000601 $366.876 8/1/20 8/1/20

J0882 55513000601 $1490.724 8/1/20 8/31/20

J0882 55513002101 $183.438 8/1/20 8/1/20

J0882 55513002101 $745.362 8/1/20 8/31/20

J0882 55513002104 $183.438 8/1/20 8/1/20

J0882 55513002104 $745.362 8/1/20 8/31/20

J0882 55513002301 $366.876 8/1/20 8/1/20

J0882 55513002301 $1490.724 8/1/20 8/31/20

J0882 55513002304 $366.876 8/1/20 8/1/20

J0882 55513002304 $1490.724 8/1/20 8/31/20

J0882 55513002501 $366.876 8/1/20 8/1/20

J0882 55513002501 $1490.724 8/1/20 8/31/20

J0882 55513002504 $366.876 8/1/20 8/1/20

J0882 55513002504 $1490.724 8/1/20 8/31/20

J0882 55513002701 $917.19 8/1/20 8/1/20

J0882 55513002701 $3726.81 8/1/20 8/31/20

J0882 55513002704 $917.19 8/1/20 8/1/20

J0882 55513002704 $3726.81 8/1/20 8/31/20

J0882 55513002801 $917.19 8/1/20 8/1/20

J0882 55513002801 $3726.81 8/1/20 8/31/20

J0882 55513003201 $917.19 8/1/20 8/1/20

J0882 55513003201 $3726.81 8/1/20 8/31/20

J0882 55513005701 $109.1892851 8/1/20 8/1/20

J0882 55513005701 $443.6678548 8/1/20 8/31/20

J0882 55513005704 $109.1892851 8/1/20 8/1/20

J0882 55513005704 $443.6678548 8/1/20 8/31/20

J0882 55513009801 $45.8595 8/1/20 8/1/20

J0882 55513009801 $186.3405 8/1/20 8/31/20

J0882 55513009804 $45.8595 8/1/20 8/1/20

J0882 55513009804 $186.3405 8/1/20 8/31/20

J0882 55513011001 $550.314 8/1/20 8/1/20

J0882 55513011001 $2236.086 8/1/20 8/31/20

J0882 55513011101 $917.19 8/1/20 8/1/20

J0882 55513011101 $3726.81 8/1/20 8/31/20

J0885 55513012601 $7.858525 8/1/20 8/1/20

J0885 55513012601 $31.931475 8/1/20 8/31/20

J0885 55513012610 $7.85892 8/1/20 8/1/20

J0885 55513012610 $31.93308 8/1/20 8/31/20

J0885 55513014401 $39.2946 8/1/20 8/1/20

J0885 55513014401 $159.6654 8/1/20 8/31/20

J0885 55513014410 $39.2946 8/1/20 8/1/20

J0885 55513014410 $159.6654 8/1/20 8/31/20

J0885 55513014801 $15.71705 8/1/20 8/1/20


of 23



End Date

J0885 55513014801 $63.86295 8/1/20 8/31/20

J0885 55513014810 $15.71784 8/1/20 8/1/20

J0885 55513014810 $63.86616 8/1/20 8/31/20

J0885 55513026701 $11.788775 8/1/20 8/1/20

J0885 55513026701 $47.901225 8/1/20 8/31/20

J0885 55513026710 $11.78838 8/1/20 8/1/20

J0885 55513026710 $47.89962 8/1/20 8/31/20

J0885 55513028301 $39.2946 8/1/20 8/1/20

J0885 55513028301 $159.6654 8/1/20 8/31/20

J0885 55513028310 $39.2946 8/1/20 8/1/20

J0885 55513028310 $159.6654 8/1/20 8/31/20

J0885 55513047801 $78.5892 8/1/20 8/1/20

J0885 55513047801 $319.3308 8/1/20 8/31/20

J0885 55513047810 $78.5892 8/1/20 8/1/20

J0885 55513047810 $319.3308 8/1/20 8/31/20

J0885 59676030200 $12.669625 8/1/20 8/1/20

J0885 59676030200 $51.480375 8/1/20 8/31/20

J0885 59676030201 $12.6699548 8/1/20 8/1/20

J0885 59676030201 $51.4817151 8/1/20 8/31/20

J0885 59676030300 $19.00345 8/1/20 8/1/20

J0885 59676030300 $77.21655 8/1/20 8/31/20

J0885 59676030301 $19.0027923 8/1/20 8/1/20

J0885 59676030301 $77.2138776 8/1/20 8/31/20

J0885 59676030400 $25.3353 8/1/20 8/1/20

J0885 59676030400 $102.9447 8/1/20 8/31/20

J0885 59676030401 $25.3353 8/1/20 8/1/20

J0885 59676030401 $102.9447 8/1/20 8/31/20

J0885 59676031000 $63.33825 8/1/20 8/1/20

J0885 59676031000 $257.36175 8/1/20 8/31/20

J0885 59676031001 $63.33825 8/1/20 8/1/20

J0885 59676031001 $257.36175 8/1/20 8/31/20

J0885 59676031002 $63.33588 8/1/20 8/1/20

J0885 59676031002 $257.35212 8/1/20 8/31/20

J0885 59676031200 $63.33825 8/1/20 8/1/20

J0885 59676031200 $257.36175 8/1/20 8/31/20

J0885 59676031204 $63.33825 8/1/20 8/1/20

J0885 59676031204 $257.36175 8/1/20 8/31/20

J0885 59676032000 $126.6765 8/1/20 8/1/20

J0885 59676032000 $514.7235 8/1/20 8/31/20

J0885 59676032004 $126.6765 8/1/20 8/1/20

J0885 59676032004 $514.7235 8/1/20 8/31/20

J0885 59676034000 $253.353 8/1/20 8/1/20

J0885 59676034000 $1029.447 8/1/20 8/31/20

J0885 59676034001 $253.353 8/1/20 8/1/20

J0885 59676034001 $1029.447 8/1/20 8/31/20

J1000 00009027101 $4.699752 8/1/20 8/1/20

J1000 00009027101 $22.945848 8/1/20 8/31/20

J1050 59762453701 $39.14 8/1/20 8/1/20

J1050 59762453701 $58.71 8/1/20 8/31/20

J1050 59762453702 $39.09856 8/1/20 8/1/20

J1050 59762453702 $58.64784 8/1/20 8/31/20

J1200 00641037625 $0.58944 8/1/20 8/1/20

J1200 00641037625 $0.6897446 8/1/20 8/31/20 J1300 25682000101 $46.3133 8/1/20 8/1/20


of 23



End Date

J1300 25682000101 $214.6067 8/1/20 8/31/20

J1301 70510217101 $1.084688 8/1/20 8/1/20

J1301 70510217101 $5.6494 8/1/20 8/31/20

J1301 70510217102 $1.084672 8/1/20 8/1/20

J1301 70510217102 $5.64935 8/1/20 8/31/20

J1303 25682002201 $40.9856 8/1/20 8/1/20

J1303 25682002201 $213.46667 8/1/20 8/31/20

J1428 60923028410 $96.00 8/1/20 8/1/20

J1428 60923028410 $800.00 8/1/20 8/31/20

J1428 60923036302 $96.00 8/1/20 8/1/20

J1428 60923036302 $800.00 8/1/20 8/31/20

J1439 00517065001 $15.0481739 8/1/20 8/1/20

J1439 00517065001 $72.1427160 8/1/20 8/31/20

J1442 55513020901 $157.437125 8/1/20 8/1/20

J1442 55513020901 $639.712875 8/1/20 8/31/20

J1442 55513020910 $157.43515 8/1/20 8/1/20

J1442 55513020910 $639.70485 8/1/20 8/31/20

J1442 55513020991 $157.437125 8/1/20 8/1/20

J1442 55513020991 $639.712875 8/1/20 8/31/20

J1442 55513053001 $74.6155 8/1/20 8/1/20

J1442 55513053001 $303.1845 8/1/20 8/31/20

J1442 55513053010 $74.6155 8/1/20 8/1/20

J1442 55513053010 $303.1845 8/1/20 8/31/20

J1442 55513054601 $74.26 8/1/20 8/1/20

J1442 55513054601 $301.74 8/1/20 8/31/20

J1442 55513054610 $74.2593838 8/1/20 8/1/20

J1442 55513054610 $301.7374962 8/1/20 8/31/20

J1442 55513092401 $158.1738 8/1/20 8/1/20

J1442 55513092401 $642.7062 8/1/20 8/31/20

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of 23



End Date

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of 23



End Date

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of 23



End Date

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of 23



End Date

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of 23



End Date

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of 23



End Date

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Q4081 55513026701 $47.901225 8/1/20 8/31/20

Q4081 55513026710 $11.78838 8/1/20 8/1/20

Q4081 55513026710 $47.89962 8/1/20 8/31/20

Q4081 55513028301 $39.2946 8/1/20 8/1/20

Q4081 55513028301 $159.6654 8/1/20 8/31/20

Q4081 55513028310 $39.2946 8/1/20 8/1/20

Q4081 55513028310 $159.6654 8/1/20 8/31/20

Q4081 55513047801 $78.5892 8/1/20 8/1/20

Q4081 55513047801 $319.3308 8/1/20 8/31/20

Q4081 55513047810 $78.5892 8/1/20 8/1/20

Q4081 55513047810 $319.3308 8/1/20 8/31/20

Q4081 59676030200 $12.669625 8/1/20 8/1/20

Q4081 59676030200 $51.480375 8/1/20 8/31/20

Q4081 59676030201 $12.6699548 8/1/20 8/1/20

Q4081 59676030201 $51.4817151 8/1/20 8/31/20

Q4081 59676030300 $19.00345 8/1/20 8/1/20

Q4081 59676030300 $77.21655 8/1/20 8/31/20

Q4081 59676030301 $19.0027923 8/1/20 8/1/20

Q4081 59676030301 $77.2138776 8/1/20 8/31/20

Q4081 59676030400 $25.3353 8/1/20 8/1/20

Q4081 59676030400 $102.9447 8/1/20 8/31/20

Q4081 59676030401 $25.3353 8/1/20 8/1/20

Q4081 59676030401 $102.9447 8/1/20 8/31/20

Q4081 59676031000 $63.33825 8/1/20 8/1/20


of 23



End Date

Q4081 59676031000 $257.36175 8/1/20 8/31/20

Q4081 59676031001 $63.33825 8/1/20 8/1/20

Q4081 59676031001 $257.36175 8/1/20 8/31/20

Q4081 59676031002 $63.33588 8/1/20 8/1/20

Q4081 59676031002 $257.35212 8/1/20 8/31/20

Q4081 59676031200 $63.33825 8/1/20 8/1/20

Q4081 59676031200 $257.36175 8/1/20 8/31/20

Q4081 59676031204 $63.33825 8/1/20 8/1/20

Q4081 59676031204 $257.36175 8/1/20 8/31/20

Q4081 59676032000 $126.6765 8/1/20 8/1/20

Q4081 59676032000 $514.7235 8/1/20 8/31/20

Q4081 59676032004 $126.6765 8/1/20 8/1/20

Q4081 59676032004 $514.7235 8/1/20 8/31/20

Q4081 59676034000 $253.353 8/1/20 8/1/20

Q4081 59676034000 $1029.447 8/1/20 8/31/20

Q4081 59676034001 $253.353 8/1/20 8/1/20

Q4081 59676034001 $1029.447 8/1/20 8/31/20

Q5101 61314030401 $130.66205 8/1/20 8/1/20

Q5101 61314030401 $530.91795 8/1/20 8/31/20

Q5101 61314030410 $130.66284 8/1/20 8/1/20

Q5101 61314030410 $530.92116 8/1/20 8/31/20

Q5101 61314031201 $130.0488125 8/1/20 8/1/20

Q5101 61314031201 $528.4261875 8/1/20 8/31/20

Q5101 61314031210 $130.047825 8/1/20 8/1/20

Q5101 61314031210 $528.422175 8/1/20 8/31/20

Q5101 61314031801 $130.04585 8/1/20 8/1/20

Q5101 61314031801 $528.41415 8/1/20 8/31/20

Q5101 61314031805 $130.04822 8/1/20 8/1/20

Q5101 61314031805 $528.42378 8/1/20 8/31/20

Q5101 61314031810 $130.04822 8/1/20 8/1/20

Q5101 61314031810 $528.42378 8/1/20 8/31/20

Q5101 61314032601 $130.0488125 8/1/20 8/1/20

Q5101 61314032601 $528.4261875 8/1/20 8/31/20

Q5101 61314032605 $130.047825 8/1/20 8/1/20

Q5101 61314032605 $528.422175 8/1/20 8/31/20

Q5101 61314032610 $130.047825 8/1/20 8/1/20

Q5101 61314032610 $528.422175 8/1/20 8/31/20

Q5105 00069130501 $5.02968 8/1/20 8/1/20

Q5105 00069130501 $21.44232 8/1/20 8/31/20

Q5105 00069130510 $5.02968 8/1/20 8/1/20

Q5105 00069130510 $21.44232 8/1/20 8/31/20

Q5105 00069130601 $7.54452 8/1/20 8/1/20

Q5105 00069130601 $32.16348 8/1/20 8/31/20

Q5105 00069130610 $7.54452 8/1/20 8/1/20

Q5105 00069130610 $32.16348 8/1/20 8/31/20

Q5105 00069130701 $10.05936 8/1/20 8/1/20

Q5105 00069130701 $42.88464 8/1/20 8/31/20

Q5105 00069130710 $10.05936 8/1/20 8/1/20

Q5105 00069130710 $42.88464 8/1/20 8/31/20

Q5105 00069130801 $25.1484 8/1/20 8/1/20

Q5105 00069130801 $107.2116 8/1/20 8/31/20

Q5105 00069130810 $25.1484 8/1/20 8/1/20

Q5105 00069130810 $107.2116 8/1/20 8/31/20

Q5105 00069130901 $100.5936 8/1/20 8/1/20


of 23



End Date

Q5105 00069130901 $428.8464 8/1/20 8/31/20

Q5105 00069130904 $100.5936 8/1/20 8/1/20

Q5105 00069130904 $428.8464 8/1/20 8/31/20

Q5105 59353000201 $5.0293 8/1/20 8/1/20

Q5105 59353000201 $21.4407 8/1/20 8/31/20

Q5105 59353000210 $5.02968 8/1/20 8/1/20

Q5105 59353000210 $21.44232 8/1/20 8/31/20

Q5105 59353000301 $7.5449 8/1/20 8/1/20

Q5105 59353000301 $32.1651 8/1/20 8/31/20

Q5105 59353000310 $7.54452 8/1/20 8/1/20

Q5105 59353000310 $32.16348 8/1/20 8/31/20

Q5105 59353000401 $10.0586 8/1/20 8/1/20

Q5105 59353000401 $42.8814 8/1/20 8/31/20

Q5105 59353000410 $10.05936 8/1/20 8/1/20

Q5105 59353000410 $42.88464 8/1/20 8/31/20

Q5105 59353001001 $25.1484 8/1/20 8/1/20

Q5105 59353001001 $107.2116 8/1/20 8/31/20

Q5105 59353001010 $25.1484 8/1/20 8/1/20

Q5105 59353001010 $107.2116 8/1/20 8/31/20

Q5106 00069130501 $5.02968 8/1/20 8/1/20

Q5106 00069130501 $21.44232 8/1/20 8/31/20

Q5106 00069130510 $5.02968 8/1/20 8/1/20

Q5106 00069130510 $21.44232 8/1/20 8/31/20

Q5106 00069130601 $7.54452 8/1/20 8/1/20

Q5106 00069130601 $32.16348 8/1/20 8/31/20

Q5106 00069130610 $7.54452 8/1/20 8/1/20

Q5106 00069130610 $32.16348 8/1/20 8/31/20

Q5106 00069130701 $10.05936 8/1/20 8/1/20

Q5106 00069130701 $42.88464 8/1/20 8/31/20

Q5106 00069130710 $10.05936 8/1/20 8/1/20

Q5106 00069130710 $42.88464 8/1/20 8/31/20

Q5106 00069130801 $25.1484 8/1/20 8/1/20

Q5106 00069130801 $107.2116 8/1/20 8/31/20

Q5106 00069130810 $25.1484 8/1/20 8/1/20

Q5106 00069130810 $107.2116 8/1/20 8/31/20

Q5106 00069130901 $100.5936 8/1/20 8/1/20

Q5106 00069130901 $428.8464 8/1/20 8/31/20

Q5106 00069130904 $100.5936 8/1/20 8/1/20

Q5106 00069130904 $428.8464 8/1/20 8/31/20

Q5106 59353000201 $5.0293 8/1/20 8/1/20

Q5106 59353000201 $21.4407 8/1/20 8/31/20

Q5106 59353000210 $5.02968 8/1/20 8/1/20

Q5106 59353000210 $21.44232 8/1/20 8/31/20

Q5106 59353000301 $7.5449 8/1/20 8/1/20

Q5106 59353000301 $32.1651 8/1/20 8/31/20

Q5106 59353000310 $7.54452 8/1/20 8/1/20

Q5106 59353000310 $32.16348 8/1/20 8/31/20

Q5106 59353000401 $10.0586 8/1/20 8/1/20

Q5106 59353000401 $42.8814 8/1/20 8/31/20

Q5106 59353000410 $10.05936 8/1/20 8/1/20

Q5106 59353000410 $42.88464 8/1/20 8/31/20

Q5106 59353001001 $25.1484 8/1/20 8/1/20

Q5106 59353001001 $107.2116 8/1/20 8/31/20

Q5106 59353001010 $25.1484 8/1/20 8/1/20


of 23



End Date

Q5106 59353001010 $107.2116 8/1/20 8/31/20

Q5110 00069029101 $103.806 8/1/20 8/1/20

Q5110 00069029101 $421.794 8/1/20 8/31/20

Q5110 00069029110 $103.806 8/1/20 8/1/20

Q5110 00069029110 $421.794 8/1/20 8/31/20

Q5110 00069029201 $103.806 8/1/20 8/1/20

Q5110 00069029201 $421.794 8/1/20 8/31/20

Q5110 00069029210 $103.806 8/1/20 8/1/20

Q5110 00069029210 $421.794 8/1/20 8/31/20

Q9991 12496010001 $637.056 8/1/20 8/1/20

Q9991 12496010001 $3318.00 8/1/20 8/31/20

Q9992 12496030001 $212.352 8/1/20 8/1/20

Q9992 12496030001 $1106.00 8/1/20 8/31/20

S0189 66887000410 $21.44737 8/1/20 8/1/20

S0189 66887000410 $104.71363 8/1/20 8/31/20

S0189 66887000420 $21.447506 8/1/20 8/1/20

S0189 66887000420 $104.714294 8/1/20 8/31/20

Clinical Lab Update

(Posted 5/15/20)


Effective Date

End Date

86318 $18.09 3/1/20 8/14/20 86318 TC $18.09 3/1/20 8/14/20

86318 moved from Clinical Lab Schedule to Other Codes Schedule

Other Codes Update

(Posted 5/15/20)


Effective Date

End Date

86318 $18.09 8/15/20 86318 26 $18.09 8/15/20 86318 TC $18.09 8/15/20 86328 $9.95 4/10/20 4/10/20 86328 $18.09 4/10/20 86328 26 $9.95 4/10/20 4/10/20 86328 26 $18.09 4/10/20 86328 TC $9.95 4/10/20 4/10/20 86328 TC $18.09 4/10/20

86769 $7.87 4/10/20 4/10/20

86769 $12.88 4/10/20

86769 26 $7.87 4/10/20 4/10/20

86769 26 $12.88 4/10/20

86769 TC $7.87 4/10/20 4/10/20

86769 TC $12.88 4/10/20

86318 moved from Clinical Lab Schedule to Other Codes Schedule


of 23



Date




Date


DME Update (Posted 3/31/20)


Effective Date

End Date

A9276 $10.28 3/1/20 3/1/20

A9276 $11.89 3/1/20

A9276 NU $10.28 3/1/20 3/1/20

A9276 NU $11.89 3/1/20

A9276 RR $1.03 6/1/20 6/1/20

A9276 RR $1.19 6/1/20

A9277 $570.00 3/1/20 3/1/20

A9277 $649.00 3/1/20

A9277 NU $570.00 3/1/20 3/1/20

A9277 NU $649.00 3/1/20

A9277 RR $57.00 3/1/20 3/1/20

A9277 RR $64.90 3/1/20

A9278 $438.00 3/1/20 3/1/20

A9278 $550.00 3/1/20

A9278 NU $438.00 3/1/20 3/1/20

A9278 NU $550.00 3/1/20

A9278 RR $10.00 3/1/20 3/1/20

A9278 RR $55.00 3/1/20

DME Update (Posted 3/1/20)


Effective Date

End Date

Refer to the 2020 DME and P&O Fee Schedule for procedure codes and pricing changes made effective 6/1/20.



Date Refer to the NDC Drug Schedule for procedure codes, NDC and pricing changes for the Monthly NDC Drug Update effective 6/1/20.


of 23



End Date

90670 00005197102 $440.53 5/1/20 5/1/20

90670 00005197102 $470.93 5/1/20 5/31/20

90621 00005010010 $326.48 5/1/20 5/1/20

90621 00005010010 $348.99 5/1/20 5/31/20



End Date

90700 49281028610 $72.17 4/10/20 4/10/20

90700 49281028610 $74.18 4/10/20 4/30/20

90696 49281056210 $124.32 4/10/20 4/10/20

90696 49281056210 $127.83 4/10/20 4/30/20

90698 49281051005 $112.48 4/10/20 4/10/20

90698 49281051005 $116.80 4/10/20 4/30/20

90713 49281086010 $78.49 4/10/20 4/10/20

90713 49281086010 $82.30 4/10/20 4/30/20

90648 49281054503 $19.32 4/10/20 4/10/20

90648 49281054503 $20.05 4/10/20 4/30/20

90734 49281058905 $286.21 4/10/20 4/10/20

90734 49281058905 $300.41 4/10/20 4/30/20

90714 49281021515 $79.16 4/10/20 4/10/20

90714 49281021515 $81.43 4/10/20 4/30/20

90714 49281021510 $79.16 4/10/20 4/10/20

90714 49281021510 $81.43 4/10/20 4/30/20

90715 49281040010 $106.47 4/10/20 4/10/20

90715 49281040010 $109.51 4/10/20 4/30/20

90715 49281040020 $106.47 4/10/20 4/10/20

90715 49281040020 $109.51 4/10/20 4/30/20

90670 00005197102 $440.53 4/10/20 4/10/20

90670 00005197102 $470.93 4/10/20 4/30/20

90621 00005010010 $326.48 4/10/20 4/10/20

90621 00005010010 $348.99 4/10/20 4/30/20



End Date

90700 49281028610 $72.17 3/1/20 3/1/20

90700 49281028610 $74.18 3/1/20 4/9/20

90696 49281056210 $124.32 3/1/20 3/1/20

90696 49281056210 $127.83 3/1/20 4/9/20

90698 49281051005 $112.48 3/1/20 3/1/20

90698 49281051005 $116.80 3/1/20 4/9/20

90713 49281086010 $78.49 3/1/20 3/1/20

90713 49281086010 $82.30 3/1/20 4/9/20

90648 49281054503 $19.32 3/1/20 3/1/20

90648 49281054503 $20.05 3/1/20 4/9/20

90734 49281058905 $286.21 3/1/20 3/1/20

90734 49281058905 $300.41 3/1/20 4/9/20


of 23



End Date

90714 49281021515 $79.16 3/1/20 3/1/20

90714 49281021515 $81.43 3/1/20 4/9/20

90714 49281021510 $79.16 3/1/20 3/1/20

90714 49281021510 $81.43 3/1/20 4/9/20

90715 49281040010 $106.47 3/1/20 3/1/20

90715 49281040010 $109.51 3/1/20 4/9/20

90715 49281040020 $106.47 3/1/20 3/1/20

90715 49281040020 $109.51 3/1/20 4/9/20

90670 00005197102 $440.53 3/1/20 3/1/20

90670 00005197102 $470.93 3/1/20 4/9/20

90621 00005010010 $326.48 3/1/20 3/1/20

90621 00005010010 $348.99 3/1/20 4/9/20

Other Codes Update

(Posted 2/15/20)


Effective Date

End Date

95715 $411.57 1/1/20 1/1/20

95715 $1,639.66 1/1/20

95715 26 $89.38 1/1/20 1/1/20

95715 26 $317.91 1/1/20

95715 TC $322.19 1/1/20 1/1/20

95715 TC $1,321.75 1/1/20



Date

Refer to the NDC Drug Schedule for procedure codes, NDC and pricing changes for the Monthly NDC Drug Update effective 5/1/20



Date

Refer to the NDC Drug Schedule for procedure codes, NDC and pricing changes for the Monthly NDC Drug Update effective 4/10/20

Other Codes Update (Posted 12/10/19)


Effective Date

End Date

D0414 $54.06 3/1/20 3/1/20

D0414 $81.00 3/1/20

D0417 $18.02 3/1/20 3/1/20

D0417 $79.00 3/1/20

D2971 $112.30 3/1/20 3/1/20

D2971 $112.50 3/1/20


of 23



Effective Date

End Date

D3110 $45.05 3/1/20 3/1/20

D3110 $121.00 3/1/20

D3220 $108.12 3/1/20 3/1/20

D3220 $247.00 3/1/20

D3222 $115.33 3/1/20 3/1/20

D3222 $251.00 3/1/20

D3310 $367.60 3/1/20 3/1/20

D3310 $1,029.00 3/1/20

D3320 $414.45 3/1/20 3/1/20

D3320 $1,261.00 3/1/20

D3330 $504.55 3/1/20 3/1/20

D3330 $1,564.00 3/1/20

D3410 $327.96 3/1/20 3/1/20

D3410 $1,399.00 3/1/20

D3430 $108.12 3/1/20 3/1/20

D3430 $438.00 3/1/20

D4210 $342.37 3/1/20 3/1/20

D4210 $935.00 3/1/20

D4283 $299.12 3/1/20 3/1/20

D4283 $1,460.00 3/1/20

D4285 $255.88 3/1/20 3/1/20

D4285 $1,099.00 3/1/20

D5933 $540.59 3/1/20 3/1/20

D5933 $753.11 3/1/20

D5991 $97.31 3/1/20 3/1/20

D5991 $215.00 3/1/20

D6012 $900.98 3/1/20 3/1/20

D6012 $3,227.00 3/1/20

D6091 $317.14 3/1/20 3/1/20

D6091 $774.00 3/1/20

D6092 $82.89 3/1/20 3/1/20

D6092 $151.00 3/1/20

D6093 $90.10 3/1/20 3/1/20

D6093 $237.00 3/1/20

D6245 $544.19 3/1/20 3/1/20

D6245 $1,506.00 3/1/20

D6545 $342.37 3/1/20 3/1/20

D6545 $536.00 3/1/20

D6548 $493.74 3/1/20 3/1/20

D6548 $589.00 3/1/20

D6720 $720.78 3/1/20 3/1/20

D6720 $1,420.00 3/1/20

D6721 $540.59 3/1/20 3/1/20

D6721 $1,347.00 3/1/20

D6722 $612.66 3/1/20 3/1/20

D6722 $1,371.00 3/1/20

D6740 $576.63 3/1/20 3/1/20

D6740 $1,493.00 3/1/20

D6750 $864.94 3/1/20 3/1/20

D6750 $1,454.00 3/1/20

D6751 $576.63 3/1/20 3/1/20

D6751 $1,357.00 3/1/20

D6752 $720.78 3/1/20 3/1/20

D6752 $1,389.00 3/1/20


of 23



Effective Date

End Date

D6780 $684.74 3/1/20 3/1/20

D6780 $1,371.00 3/1/20

D6781 $562.21 3/1/20 3/1/20

D6781 $1,371.00 3/1/20

D6782 $565.81 3/1/20 3/1/20

D6782 $1,274.00 3/1/20

D6783 $569.42 3/1/20 3/1/20

D6783 $1,412.00 3/1/20

D7111 $72.08 3/1/20 3/1/20

D7111 $169.00 3/1/20

D7210 $144.16 3/1/20 3/1/20

D7210 $356.00 3/1/20

D7220 $165.78 3/1/20 3/1/20

D7220 $422.00 3/1/20

D7230 $216.23 3/1/20 3/1/20

D7230 $561.00 3/1/20

D7240 $259.48 3/1/20 3/1/20

D7240 $659.00 3/1/20

D7241 $360.39 3/1/20 3/1/20

D7241 $828.00 3/1/20

D7261 $378.41 3/1/20 3/1/20

D7261 $1,152.00 3/1/20

D7282 $263.09 3/1/20 3/1/20

D7282 $403.00 3/1/20

D7287 $79.29 3/1/20 3/1/20

D7287 $277.00 3/1/20

D7310 $151.36 3/1/20 3/1/20

D7310 $485.00 3/1/20

D7320 $191.01 3/1/20 3/1/20

D7320 $788.00 3/1/20

D7340 $432.47 3/1/20 3/1/20

D7340 $3,334.00 3/1/20

D7411 $299.12 3/1/20 3/1/20

D7411 $2,303.00 3/1/20

D7412 $392.83 3/1/20 3/1/20

D7412 $2,546.00 3/1/20

D7413 $360.39 3/1/20 3/1/20

D7413 $1,697.00 3/1/20

D7414 $508.15 3/1/20 3/1/20

D7414 $2,546.00 3/1/20

D7415 $511.76 3/1/20 3/1/20

D7415 $2,849.00 3/1/20

D7450 $245.07 3/1/20 3/1/20

D7450 $1,455.00 3/1/20

D7451 $317.14 3/1/20 3/1/20

D7451 $1,988.00 3/1/20

D7460 $241.46 3/1/20 3/1/20

D7460 $1,455.00 3/1/20

D7461 $342.37 3/1/20 3/1/20

D7461 $1,988.00 3/1/20

D7471 $306.33 3/1/20 3/1/20

D7471 $1,801.00 3/1/20

D7472 $378.41 3/1/20 3/1/20

D7472 $2,141.00 3/1/20


of 23



Effective Date

End Date

D7473 $259.48 3/1/20 3/1/20

D7473 $2,020.00 3/1/20

D7510 $97.31 3/1/20 3/1/20

D7510 $521.00 3/1/20

D7671 $432.47 3/1/20 3/1/20

D7671 $4,303.00 3/1/20

D7771 $846.92 3/1/20 3/1/20

D7771 $3,564.00 3/1/20

D7960 $216.23 3/1/20 3/1/20

D7960 $667.00 3/1/20

D7972 $371.20 3/1/20 3/1/20

D7972 $1,358.00 3/1/20

D8210 $428.87 3/1/20 3/1/20

D8210 $1,500.00 3/1/20

D8220 $515.36 3/1/20 3/1/20

D8220 $1,500.00 3/1/20

D9222 $93.70 3/1/20 3/1/20

D9222 $211.00 3/1/20

D9223 $93.70 3/1/20 3/1/20

D9223 $269.00 3/1/20

D9239 $86.49 3/1/20 3/1/20

D9239 $179.00 3/1/20

D9243 $86.49 3/1/20 3/1/20

D9243 $227.00 3/1/20

D9410 $108.12 3/1/20 3/1/20

D9410 $234.00 3/1/20

D9420 $108.12 3/1/20 3/1/20

D9420 $378.00 3/1/20

D9430 $43.25 3/1/20 3/1/20

D9430 $75.00 3/1/20

D9951 $82.89 3/1/20 3/1/20

D9951 $119.02 3/1/20

2020 reimbursement changes/updates · 2020. 8. 4. · 2020 reimbursement changes/updates page 2 of...

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