Medicare AdvantageCoverageHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·Cardiology, Oncology, Gastroenterology +1 more·Physician / Facility
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple medical policy updates take effect July 1, 2025, affecting various testing services and prior authorization requirements. Key changes include biomarker testing moving from prior auth required to not covered for Medicare Advantage, phototherapy becoming covered for Medicare Advantage, and numerous genetic/molecular testing codes having prior authorization removed or coverage criteria changes.
Action Required
By June 30, 2025: Billing team must update billing system to reflect multiple changes: 1) Stop processing prior authorizations for CPT codes 0119U and 0052U for Medicare Advantage - these are now not covered, 2) Remove prior auth requirements for HCPCS E0203 phototherapy for Medicare Advantage plans, 3) Add ICD-10 C84.7B as covered diagnosis for CPT 86300 on commercial plans, 4) Remove prior authorization requirements for numerous genetic testing codes (0101U, 0102U, 0103U, 0129U, 0209U, 0007U) across all plans, 5) Update medical necessity review criteria for multiple PLA/MAAA codes to use new policy guidelines. Update encounter forms and train staff on coverage changes to prevent claim denials.