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Reimbursement Rates for 2019 Codes

Each year, the American Medical Association (AMA) editorial board updates the list of CPT® codes by adding new codes and revising or deleting certain existing codes.¹ The Centers for Medicare & Medicaid Services (CMS) reviews this updated information and assigns Relative Value Units (RVUs) based on its analysis of the labor and resource input costs to each newly identified CPT code. Once CMS makes its RVU information available, Horizon BCBSNJ uses this data to help us establish new rates for these new CPT codes.

CMS began releasing RVU information in December 2018. Horizon BCBSNJ is in the process of obtaining all necessary information required to update our pricing files.

We anticipate that our pricing file updates will be completed no later than February 1, 2019.

The processing of certain 2019 claims that include new or revised CPT codes may be delayed until our files are updated. All impacted claims will be finalized following the completion of our file updates. Please do not resubmit claims or submit claim appeals.

We apologize for any inconvenience this may cause.

¹ Information on the new and updated CPT codes is available on the AMA website.

CPT® is a registered mark of the American Medical Association.

Published on: January 11, 2019, 11:29 a.m. ET
Last updated on: January 11, 2019, 11:39 a.m. ET