All PlansCoverageHigh impact
New and Emerging Medical Technologies and Procedures
Regence BlueShield·Cardiology, Cardiothoracic Surgery, Ophthalmology +7 more·Coding
Effective date
Jul 1, 2026
We identified it
Jul 7, 2026
Summary
Effective July 1, 2026, this policy designates 50+ new and emerging medical technology CPT codes (0075T through 0505T) as investigational and therefore non-covered services. Billing teams must immediately identify these codes in their systems and flag them for patient financial responsibility notices before service delivery. Providers may bill members directly for these investigational procedures, but members must be informed in advance that they will be responsible for costs.
Action Required
By June 30, 2026: (1) Billing team must update billing system to mark all 55 affected CPT codes (0075T, 0076T, 0198T, 0207T, 0219T-0222T, 0234T-0238T, 0329T-0332T, 0342T, 0347T-0350T, 0351T-0354T, 0358T, 0378T-0379T, 0408T-0418T, 0422T, 0437T, 0443T-0450T, 0481T, 0485T-0486T, 0489T-0490T, 0505T) as investigational/non-covered for all plan types. (2) Create or update patient financial responsibility forms and Advance Beneficiary Notices (ABN) templates to inform patients in writing before service delivery that these procedures are investigational and patient will be responsible for full cost. (3) Providers and clinical staff must present ABN to patients before rendering any of these services; obtain patient signature confirming understanding of financial responsibility. (4) Update encounter templates and pre-visit questionnaires to flag when these codes are being used. (5) Train front desk, clinical, and billing staff on the investigational status and notification requirements. Failure to obtain signed ABN prior to service will result in claims denial and potential compliance issues. Contract language takes precedence over this policy in case of conflict.