New York Providers: Empire non-covered services for Managed Medicaid Care

NOTE: This announcement was published in Empire NY Providers communication section on FEB 1,2020

According to Empire BCBS Health Plus (NY)- starting back in 12/1/2019- they began denying claims that were billed with non-covered codes (NY Medicaid).

HCPCS and CPT codes that are not on the NY Medicaid fee schedule are considered non-covered.

This policy affects only MMC and Child Health Plus programs.

Empire suggests that some of these non covered codes should be billed with a more appropriate code or a code that is considered (bundled).

For the list of COVERED codes please click on https://www.emedny.org.

For a complete list of NON covered CPT/HCPCS codes please visit: https://mediproviders.empireblue.com/ProviderUpdates/NYNY_CAID_PU_NoncoveredCPTHCPCSCodes.pdf

Providers should bill the most current CPT or HCPCS code on the current NY Fee Schedule to avoid unnecessary denials.

If you have questions about this announcement please contact your Provider Relations Representative or the Provider Services: 1-800-450-8753