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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Coverage · Physician / Facility · RI · Oncology, Radiology, CardiologyMedium impact

Medical policy updates

Act
by May 1, 2025
Effective date
May 1, 2025
Identified
Jun 19, 2026

Summary

BCBSRI has updated medical policies effective May 1 and June 1, 2025, affecting prior authorization requirements for durable medical equipment, expanding covered diagnosis codes for CA-125 testing and cardiovascular biomarker testing, and adding new requirements for human leukocyte antigen testing with mandatory modifier usage.

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What to do

by May 1, 2025 · 2 steps
01Update billing system to include new covered ICD-10 codes E10.A0-E10.A2, E88.810, E88.82 for CPT codes 83700, 83701, 83704 and codes T45.AX1A-T45.AX5S, Z92.26 for CPT 82610.
02By June 1, 2025: Configure system to use web-based authorization tool for HCPCS E2513, add ICD-10 codes R19.01-R19.04 as covered for CPT 86304, and ensure Modifier 32 is automatically applied to CPT codes 81370-81383 and 86812, 86817, 86821, 86825, 86826, 86829-86835 for Rhode Island HLA testing mandate.

Codes mentioned

E2513R19.01R19.02R19.03R19.04863048137081371813728137381374813758137681377813788137981380813818138281383868128681786821868258682686829868308683186832868338683486835E10.A0E10.A1E10.A2E88.810E88.82837008370183704T45.AX1AT45.AX5SZ92.2682610

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 →
Policy updatesHighEffective Apr 1, 2024 · Physician / FacilityMedical policy updatesMediumEffective Mar 1, 2026 · Provider UpdateMedical policy updatesHighEffective Jun 1, 2026 · Physician / FacilityPolicies related to the BIOMARKER Testing Mandate, effective January 1, 2024HighEffective Jan 1, 2024 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list

Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesOncologyRadiologyCardiologyCode E2513Code R19.01Code R19.02Code R19.03Code R19.04Code 86304Code 81370Code 81371Code 81372Code 81373Code 81374Code 81375Code 81376Code 81377Code 81378Code 81379Code 81380Code 81381Code 81382Code 81383Code 86812Code 86817Code 86821Code 86825Code 86826Code 86829Code 86830Code 86831Code 86832Code 86833Code 86834Code 86835Code E10.A0Code E10.A1Code E10.A2Code E88.810Code E88.82Code 83700Code 83701Code 83704Code T45.AX1ACode T45.AX5SCode Z92.26Code 82610

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