Blue Cross Blue Shield Oklahoma non‑reimbursable codes | OpenPayer
CurrentBlue Cross Blue Shield - OklahomaPolicy N/A
Non‑reimbursable procedure codes list
This document lists procedure (CPT/HCPCS) codes that Blue Cross Blue Shield - Oklahoma identifies as not reimbursable under members' plan documents; it affects providers submitting claims to this payer.
Policy Summary
PayerBlue Cross Blue Shield - Oklahoma
PolicyNon‑reimbursable procedure codes list
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionDo not expect reimbursement for listed procedure codes unless the member's plan documents indicate otherwise.
No material clinical or coverage changes in this revision.
~400+procedure codes listed as non‑reimbursable in this partial extract
20+code entries in excerpt (T/C/A/E codes)
~283product lines referenced (Q-codes)
2020–2026effective dates span
Scope & Coverage Stance
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.
Coverage stance for listed codes (partial)
Codes listed are identified as not reimbursable based on members' plan documents.
Listed procedure codes are identified as not reimbursable under members' plan documents.
Presence on this list indicates expected denial or nonpayment unless the member's plan documents specify otherwise.
Code list — Code listings and effective/end dates
Code listings and effective/end dates
ANY of the following
CPT Category III (T) codes with descriptions and effective/end dates where provided (examples: 0435T, 0436T, 0444T, 0445T, many with EFFECTIVE DATE = 1/1/2026).
HCPCS A-codes and other HCPCS/C-category entries with descriptions and EFFECTIVE DATE/END DATE fields (examples: A2001, A2011, A4540, A4560).
Sample CPT/HCPCS/E/C-code and other entries with descriptions and EFFECTIVE DATE/END DATE fields (examples: C9771, E0221, Q4155 and Q4324–Q4336 product codes).
Each code entry in the listing includes DESCRIPTION, EFFECTIVE DATE, and END DATE when provided; absence of an END DATE indicates an open-ended entry in the extract.
Coverage stance from excerpt — This excerpt provides code-level metadata (descriptions and active date ranges). It does not include coverage determinations, medical nec...
This excerpt provides code-level metadata (descriptions and active date ranges). It does not include coverage determinations, medical necessity criteria, or payment rules.
Excerpt contains code identifiers with DESCRIPTION, EFFECTIVE DATE, and END DATE fields but does not specify authorization, medical necessity criteria, or explicit coverage determinations in these lines.
Product effective-date registry
Product listing (no coverage decision text in this extract):
Internal Q-code product registry entries list product identifier, short product description (often including unit such as PER SQ CM), EFFECTIVE DATE, and END DATE when provided (examples: Q4155 NEOXFLO/CLARIXFLO EFFECTIVE DATE = 12/01/2020; Q4324–Q4336 with EFFECTIVE DATE = 07/01/2024–05/15/2025).
Informational code/effective date listings — Reference listings (no explicit coverage criteria present in these chunks).
Reference listings (no explicit coverage criteria present in these chunks).
Entries are informational code/effective-date listings; the extract enumerates codes and effective dates (for example, Q4325 ACAPATCH PER SQ CM EFFECTIVE DATE = 07/01/2024; numerous Category III CPT temporary codes with EFFECTIVE DATE = 1/1/2026) and does not include authorization or medical necessity criteria within these excerpts.
programming evaluation (apnea study) - shows EFFECTIVE DATE = 04/15/2022, END DATE = 12/31/2023
0436T
programming evaluation - EFFECTIVE DATE = 04/15/2022, END DATE = 12/31/2023
0444T
initial placement of a drug eluting - EFFECTIVE DATE = 12/01/2020, END DATE = 12/31/2022
HCPCS A-codes (wound matrices/supplies)HCPCS
A2001
INNOVAMATRIX AC, PER SQ CM - EFFECTIVE DATE = 04/15/2022
A2011
SUPRA SDRM, PER SQUARE CENTIMETER - EFFECTIVE DATE = 04/01/2022
Category III/other C-codesHCPCS
C1052
HEMOSTATIC AGENT, GI, TOPIC - EFFECTIVE DATE = 05/15/2021
C9771
NSLISINS CRYO POST NASAL TIS - EFFECTIVE DATE = 07/15/2021, END DATE = 12/31/2023
sample codes from excerptmixed
C9771
NSLISINS CRYO POST NASAL TIS
E0221
INFRARED HEATING PAD SYSTEM
E0469
LUNG EXPANS HIGH OSCIL NEB
Internal Q-code product registrymixed
Q4155–Q4336 (non-contiguous)
Internal Q-code identifiers for listed biologic/amniotic/skin graft products; each code maps to a product description and effective/end dates in the listing.
HCPCS Q-codes (graft products)HCPCS
Q4324-Q4367 (examples)
Various allograft/amnion/dermal matrix product codes listed with per sq cm pricing/description
Category III CPT (T) codesCPT
0075T-1025T (range example)
Numerous Category III (T) CPT codes listed with effective date 1/1/2026
Misc HCPCS/S codesHCPCS
S2117-S9056 (examples)
Various S-codes and miscellaneous HCPCS codes with older effective dates (e.g., 12/01/2020, 09/01/2020)
What Providers Need to Know
Billing Rule
Non‑reimbursable procedure codes — HCPCS Level II A-code entries
Reimbursement Information: The following list of procedure codes identifies services that are not reimbursable based on the member's plan documents. Providers should not expect reimbursement for the listed codes; verify member coverage and prior authorization requirements separately.
HCPCS Level II A-codes (entries and effective dates) include: A2001 — INNOVAMATRIX AC, PER SQ CM; EFFECTIVE DATE = 04/15/2022. A2002 — MIRRAGEN ADV WND MAT, PER SQ CM; EFFECTIVE DATE = 04/15/2022. A2004 — XCELLISTEM, PER SQ CM; EFFECTIVE DATE = 04/15/2022. A2005 — MICROLYTE MATRIX, PER SQ CM; EFFECTIVE DATE = 04/15/2022. A2006 — NOVOSORB SYNPATH, PER SQ CM; EFFECTIVE DATE = 04/15/2022. A2007 — RESTRATA, PER SQ CM; EFFECTIVE DATE = 04/15/2022. A2008 — THERAGENESIS, PER SQ CM; EFFECTIVE DATE = 04/15/2022. A2010 — APIS, PER SQUARE CENTIMETER; EFFECTIVE DATE = 04/15/2022. A2011 — SUPRA SDRM, PER (effective date listed as 05/15/2024 in source). A4540 (entry present), EFFECTIVE DATE = 05/15/2024. A4542 — SUPP EXT UP LIMB TREMOR STIM; EFFECTIVE DATE = 05/15/2024. A4543 — SUPPLY TRANS ELEC NERVE STIM; EFFECTIVE DATE = 05/15/2025. A4560 — NMES DISPOSABLE; EFFECTIVE DATE = 01/15/2024. A4575 — TOPICAL HYPERBACI OXYGEN CHAMBER D; EFFECTIVE DATE = 12/01/2020. A4596 — CES SYSTEM MONTHLY SUPP; EFFECTIVE DATE = 04/01/2023. A4639 — INFRARED HT SYS REPLCMNT PAD; EFFECTIVE DATE = 09/01/2020. A6000 (A6ooo in source) — WOUND WARMING WOUND COVER; EFFECTIVE DATE = 09/01/2020. A7021 — SUPPL AND ACCESS LUNG EXPAN; EFFECTIVE DATE = 05/15/2025. A7049 — EPAP NASAL VALVE; EFFECTIVE DATE = 09/01/2023. A9268 — PROGRAMMER ORALLY INGEST CAP; EFFECTIVE DATE = 06/15/2025 (END DATE = 06/15/2025).
Providers should review each code's effective and end dates when billing; presence on this list indicates the code has been identified as non-reimbursable for at least some time periods. If a code has an end date blank, the non-reimbursable status may be ongoing.
Note
CPT Category III (T) code effective dates
The following CPT Category III (T) codes are listed with an effective date of 1/1/2026. Providers should note these effective dates when submitting claims; codes on this list have been captured from the source and may be subject to policy-level reimbursement restrictions.
0075T — EFFECTIVE DATE = 01/01/2026.
00761T — EFFECTIVE DATE = 01/01/2026.
0100T — EFFECTIVE DATE = 01/01/2026.
0174T — EFFECTIVE DATE = 01/01/2026.
0175T — EFFECTIVE DATE = 01/01/2026.
0201T — EFFECTIVE DATE = 01/01/2026.
0208T — EFFECTIVE DATE = 01/01/2026.
0209T — EFFECTIVE DATE = 01/01/2026.
0210T — EFFECTIVE DATE = 01/01/2026.
0211T — EFFECTIVE DATE = 01/01/2026.
0219T — EFFECTIVE DATE = 01/01/2026.
0234T — EFFECTIVE DATE = 01/01/2026.
0235T — EFFECTIVE DATE = 01/01/2026.
0236T — EFFECTIVE DATE = 01/01/2026.
0237T — EFFECTIVE DATE = 01/01/2026.
0238T — EFFECTIVE DATE = 01/01/2026.
Terminology & Entry Format
Non‑reimbursable — Definition
DefinitionProcedure codes identified as not payable under the member's plan documents; presence on this list indicates expected denial or nonpayment unless plan terms indicate otherwise.
Implication for providersProviders should not expect reimbursement for codes listed here unless a member's plan documents explicitly allow payment.
ScopeList may not be all‑inclusive; absence of a code from the partial extract does not imply coverage.
Usage noteEach code entry may include EFFECTIVE DATE and END DATE fields that specify when the non‑reimbursable status applies.
Code entry format — short description + dates
Entry componentsCode identifier, short description, EFFECTIVE DATE, and END DATE fields shown per entry.
Example format0436T, DESCRIPTION = PRGRMG EVAL NPGS APNEA STUDY. 0436T, EFFECTIVE DATE = 04/15/2022. 0436T, END DATE = 12/31/2023.
Date fieldsEFFECTIVE DATE and END DATE may be present and indicate the active range for the listed entry.
Partial listingsEntries in the document are presented sequentially; the extract includes several T‑code examples with dates.
Code entry format — description + dates
Entry componentsCode identifier followed by DESCRIPTION, EFFECTIVE DATE, and END DATE fields.
Example formatC9771, DESCRIPTION = NSLISINS CRYO POST NASAL TIS. C9771, EFFECTIVE DATE = 07/15/2021. C9771, END DATE = 12/31/2023.
End date optionalitySome entries show an END DATE; others leave END DATE blank indicating ongoing status.
PurposeProvides code‑level metadata (descriptions and active date ranges) without coverage decision text in the excerpt.
Q-code product entry
Registry line itemEach line lists an internal Q‑code, a short product description (often indicating unit like PER SQ CM), an EFFECTIVE DATE, and an optional END DATE.
Example entryQ4155, DESCRIPTION = NEOXFLO OR CLARIXFLO MG. Q4155, EFFECTIVE DATE = 12/01/2020. Q4155, END DATE = .
Product typesEntries correspond to biologic/amniotic/skin graft products and similar graft/matrix items.
Date spanEffective dates in the registry range across multiple years (examples show 12/01/2020–05/15/2025).
Per square centimeter pricing/measurement for graft/matrix products
Measurement unitPer sq cm — many graft/matrix product descriptions include 'PER SQ CM' or equivalent per‑square‑centimeter pricing/measurement.
Example entriesQ4325, DESCRIPTION = ACAPATCH, PER SQ CM. Q4325, EFFECTIVE DATE = 07/1/2024. Q4334, DESCRIPTION = AMNIOPLAST 1, PER SQ CM. Q4334, EFFECTIVE DATE = 05/15/2025.
ApplicabilityUsed for allograft/amnion/dermal matrix products where billing or pricing is specified per square centimeter.
Registry noteSome Q‑code entries list end dates while others remain open‑ended in the listing.
Category III CPT temporary codes (T) with effective date 01/01/2026
Code typeCategory III (temporary) CPT codes — 'T' codes listed with effective date 1/1/2026.
Example entries0075T, EFFECTIVE DATE = 1/1/2026. 0100T, EFFECTIVE DATE = 1/1/2026. 0444T, EFFECTIVE DATE = 1/1/2026.
Effective date commonalityNumerous Category III codes in the listing share the same effective date of 01/01/2026.
Document contextThese T‑code entries are presented as effective‑date listings; the extract does not include separate coverage determinations for them.
Policy Summary
PayerBlue Cross Blue Shield - Oklahoma
PolicyNon‑reimbursable procedure codes list
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionDo not expect reimbursement for listed procedure codes unless the member's plan documents indicate otherwise.