We have completed our review of the 20 de janeiro25 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 janeirost, 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 “for Commercial and “Not Covered" for Medicare Advantage Plans this indicates services where there is insufficient evidence to determine the  effects of the technology on health outcomes.  
• “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 Medicare Advantage Plans.
• “Individual Consideration review"- services that require supporting documentation filed with the claim for review.
• “Use Alternate Code"- services that require the use of an alternate code that is addressed in an existing policy.

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

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 janeiro25 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 code(s) will be covered and separately reimbursed for Professional and Facility providers for Medicare Advantage Plans and Commercial Products:

49186, 49187, 49188, 49189, 49190, 64466, 64467, 64468, 64469, 64473, 64474, 86581, 87513, 87564, 87594, 87626, 96041

The following vaccine code will be not covered (pharmacy benefit only) for Medicare Advantage Plans, covered for Commercial Products and separately reimbursed for Professional and Facility Providers:

90593

The following code(s) will require prior authorization for Medicare Advantage Plans and Commercial Products and will be separately reimbursed for Professional and Facility providers: 

25448, 53866, 61715, 81195, 81558, 82233, 82234, 83884, 84393, 84394, 0521U, 0522U, 0523U, 0524U, 0525U, 0526U, 0527U, 0528U, 0529U, 0530U, 0910T, 0919T, 0920T, 0921T, 0922T, 0942T, 0943T

The following code(s) will require prior authorization with (Cardiology and Radiology vendor) for Medicare Advantage Plans and Commercial Products and will be separately reimbursed for Professional and Facility Providers: 

0913T, 0914T, 0915T, 0916T, 0917T, 0918T, 0923T, 0933T

The following code(s) will be considered medically necessary when filed with a covered ICD-10 code for Medicare Advantage Plans and Commercial Products and will be separately reimbursed for Professional and Facility providers: 

81515

The following code(s) will require prior authorization for Medicare Advantage Plans and will be not medically necessary for Commercial Products and will be separately reimbursed for Professional and Facility Providers: 

51721, 55881, 55882, 66683, 92137, 0901T, 0902T, 0903T, 0904T, 0905T, 0906T, 0907T, 0908T, 0909T, 0911T, 0912T, 0924T, 0925T, 0926T, 0927T, 0928T, 0929T, 0930T, 0931T, 0932T, 0934T, 0935T, 0936T, 0937T, 0938T, 0939T, 0940T, 0941T, 0944T, 0945T, 0946T, 0947T

The following code(s) will be not covered for Medicare Advantage Plans and not medically necessary for Commercial Products and will be separately reimbursed for Professional and Facility Providers: 

53865, 60660, 60661

The following code(s) will be covered but not separately reimbursed for Medicare Advantage Plans and Commercial Products for Professional and Facility Providers: 

38225, 38226, 38227, 38228, 15011, 15012, 15013, 15014, 15015, 15016, 15017, 15018, 76014, 76015, 76016,76017, 76018, 76019, 93896, 93897, 93898, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016