Medicare AdvantagePrior AuthMedium impact
Additional CPT® Code Changes
Blue Cross Blue Shield of Rhode Island·RI·Physician
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island has updated their CPT code processing system for April 2025 codes, effective April 1, 2025. Twenty new laboratory codes (0531U-0551U) now require medical review/preauthorization for both Medicare Advantage and Commercial products, except when billed with mental health diagnosis codes F01-F99.
Action Required
Before April 1, 2025: Billing team must update system to require medical review/preauthorization for CPT codes 0531U-0551U for all BCBS RI Medicare Advantage and Commercial plans. Exception: No preauth needed when billing these codes with ICD-10 diagnosis codes F01-F99 (mental health conditions). Update encounter forms and notify providers about preauthorization requirements to avoid claim denials.