Medicare AdvantageCoverageMedium impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Hematology, Cardiology +2 more·Physician / Facility
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple coverage and prior authorization changes effective between April and May 2025, including new covered ICD-10 codes for bacterial vaginosis testing, solid tumor sequencing, and home prothrombin monitoring, plus new prior authorization requirements for TENS units and implantable device removal procedures.
Action Required
By April 1, 2025: Update billing system to add new covered ICD-10 codes I26.03 and I26.95 for prothrombin monitoring codes. Configure prior authorization requirements for HCPCS E0734 and A4542 for Medicare Advantage plans. By May 1, 2025: Add ICD-10 B37.9 as covered for CPT 81513/81514, add CPT codes 0329U and 0379U to solid tumor sequencing with prior auth required, and update CPT 0824T/0825T to require prior authorization through Cardiology and Radiology Management Program.