We have completed our review of the 20 de julho25 CPT code changes, including any category II performance measurement tracking codes and category II temporary codes for emerging technology. These updates will be added to our claims processing system and are effective 1 de julho, 2025. The list includes 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 julho25 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 will be covered for Medicare Advantage plans and commercial products opt-in and opt-out groups, and will be separately reimbursed for professional and facility providers:

0556U 0563U

The following codes will be subject to medical review for Medicare Advantage plans and commercial products for opt-in groups, and will be not covered for commercial products opt-out groups, for professional and facility providers:

0552U 0553U 0554U 0555U 0557U 0558U 0559U 0560U 0561U 0562U 0564U 0565U 0566U 0567U            0568U 0569U  0570U 0571U 0572U 0573U 0574U

The following codes will be subject to medical review for Medicare Advantage plans and commercial products for professional and facility providers:

0955T  0959T  0969T

The following codes will be subject to medical review for Medicare Advantage plans and considered not medically necessary for commercial products for professional and facility providers:

0948T  0949T  0950T  0956T  0957T  0958T  0960T  0967T  0968T  0970T  0971T  0972T  0977T 0978T            0979T  0980T  0981T  0982T  0983T  

The following codes will be considered not covered for Medicare Advantage plans and not medically necessary for commercial products for professional and facility providers:

0951T  0952T  0953T  0954T  0963T

The following codes will be considered not medically necessary for commercial products for professional and facility providers:

0964T  0965T  0966T

The following codes will be considered not separately reimbursed for Medicare Advantage plans for professional and facility providers:

0964T  0965T  0966T

The following codes will be considered not separately reimbursed for Medicare Advantage plans and commercial products for professional and facility providers:

0961T  0962T  0973T  0974T  0975T  0976T  0984T  0985T  0986T  0987T