Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·Oncology, Cardiology, Orthopedics +1 more·Physician / Facility
Effective date
Aug 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple medical policies are being updated with changes to prior authorization requirements and moving medical criteria from policies to an online authorization tool. Key changes include removing prior auth requirements for some genetic testing codes (81455, 81456) while maintaining others, and adding 76 new ICD-10 codes for mass spectrometry testing.
Action Required
By August 1, 2025: Update billing system to remove prior authorization requirements for CPT codes 81455 and 81456 for Medicare Advantage and commercial plans. By September 1, 2025: Remove diagnosis edits for CPT codes 81445, 81449, 81457, 81458, 81462, 81463, and 0048U while maintaining prior authorization requirements. By October 1, 2025: Add 76 new ICD-10 diagnosis codes for CPT 0077U and update prior authorization requirement for CPT 20975 for Medicare Advantage plans. Train staff to access medical criteria through the online authorization tool instead of printed policies for all affected codes.