Medicare AdvantageBilling CodesHigh impact
CPT code changes for July 2025
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Pathology·Physician / Facility
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island has released July 2025 CPT code changes affecting coverage, reimbursement, and prior authorization requirements for new biomarker testing codes and emerging technology codes. The changes differentiate between Medicare Advantage and commercial plans, with some codes requiring medical review and others being non-covered.
Action Required
By July 1, 2025: Billing team must update system to require prior authorization for biomarker testing codes 0552U-0574U (except 0556U, 0563U) for commercial opt-in groups and all codes 0955T, 0959T, 0969T for both plan types. Update billing rules to block codes 0951T-0954T, 0963T for Medicare Advantage as non-covered and codes 0964T-0966T as non-separately reimbursed for Medicare Advantage. Configure system to prevent separate billing for codes 0961T, 0962T, 0973T-0976T, 0984T-0987T. Notify providers that members must be informed of non-covered services before rendering them.