We have completed our review of the 20 de abril25 current procedural terminology (CPT) including any category II performance measurement tracking codes and Category III temporary codes for emerging technology. These updates will be added to our claims processing system and are effective 1 de abrilst, 2025. The lists include codes that have special coverage or payment rules for standard products. (Some employers may customize their benefits.) We have included codes for services that are:

• “Not Covered" – This includes services not covered in the main member certificate (e.g., covered as a prescription drug).
• “Not Medically Necessary" – This indicates services where there is insufficient evidence to support it.
• “Not Separately Reimbursed" – Services that are not separately reimbursed are generally included in payment for another service or are reported using another code and may not be billed to your patient.
• “Subject to Medical Review" – Preauthorization is recommended for commercial products and required for BlueCHiP for Medicare.
• “Invalid" – Use alternate procedure codes, such as a CPT or HCPCS code.
• “Medicare Lab Network" – Codes that are reimbursed to a hospital laboratory outside of the laboratory network, physicians, or urgent care center providers for BlueCHiP for Medicare.
• “Pending CMS determination" – For BlueCHiP for Medicare Category III codes.

Please submit your comments and concerns regarding coverage and payment designations to:

Email: Medical.Policy@bcbsri.org

Mail:

Blue Cross & Blue Shield of Rhode Island

Attention: Medical Policy, CPT Review

500 Exchange Street

Providence, Rhode Island 02903

Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them.

CPT is a registered trademark of the American Medical Association.

20 de abril25 CPT Updates:

Please note: Coverage and/or payment rules for code(s) below may be subject to change for Medicare Advantage Plans and/or Commercial Products.

Additionally, coverage may vary for those Commercial Products that have opted out of the Biomarker Testing Mandate.

The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products:

0531U  0532U  0534U  0535U  0536U  0537U  0538U  0539U  0540U  0541U  0542U  0543U  0544U

0545U  0546U  0547U  0548U  0549U  0550U  0551U

The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products except when filed with ICD-10 codes F01-F99:

0533U