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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Coverage · Physician / Facility · Cardiology, Oncology, Gastroenterology +1 moreHigh impact

Medical policy updates

Act
by Jun 30, 2025
Effective date
Jul 1, 2025
Identified
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.

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What to do

by Jun 30, 2025 · 2 steps
01Billing 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.
02Update encounter forms and train staff on coverage changes to prevent claim denials.

Codes mentioned

E020386300C84.7B813478134881353

Original notice

Medical policy updates
bcbsri.com · Always check the source before changing claims.
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Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
CPT code changesHighEffective Jan 1, 2021 · Provider UpdateMedical policy updatesHighEffective Jan 1, 2027 · Physician / FacilityPolicy UpdatesHighEffective Jan 1, 2023 · Physician / FacilityMedical policy updatesMediumEffective Mar 1, 2026 · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list

Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesCardiologyOncologyGastroenterologyPsychiatryCode E0203Code 86300Code C84.7BCode 81347Code 81348Code 81353

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