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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Prior Auth · Physician / Facility · RI · Orthopedics, Urology, Neurosurgery +6 moreHigh impact

Additional CPT® Code Changes January 2025

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

Summary

Blue Cross Blue Shield of Rhode Island has updated CPT code coverage and prior authorization requirements for January 2025, affecting dozens of new codes with different rules for Medicare Advantage versus Commercial plans. Many new Category III codes now require prior authorization for Medicare Advantage but are deemed not medically necessary for Commercial products.

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What to do

by Jan 1, 2025 · 4 steps
01Billing team must update system with new CPT code coverage rules for BCBS Rhode Island.
02Set up prior authorization requirements for Medicare Advantage plans for codes 25448, 53866, 61715, 81195, 81558, 82233, 82234, 83884, 84393, 84394, 0521U-0530U, 0910T, 0919T-0922T, 0942T, 0943T, and all 0901T-0947T codes.
03Configure system to deny billing of codes 53865, 60660, 60661 for all plans.
04Update encounter forms to flag codes requiring prior auth and inform providers that many Category III codes are not covered for Commercial products but require prior auth for Medicare Advantage.

Codes mentioned

491864918749188491894919064466644676446864469644736447486581875138756487594876269604190593254485386661715811958155882233822348388484393843948151551721558815588266683921375386560660606613822538226382273822815011150121501315014150151501615017150187601476015760167601776018760199389693897938989800098001980029800398004980059800698007980089800998010980119801298013980149801598016

Original notice

Additional CPT® Code Changes January 2025
bcbsri.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
Additional CPT® Code Changes January 2025HighEffective Jan 1, 2025 · Physician / FacilityCPT code changes for January 2025HighEffective Jan 1, 2025 · Physician / FacilityPayment Policy UpdatesHighEffective Jan 1, 2025 · Physician / FacilityMedical policy updatesHighEffective Oct 1, 2025 · 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 changesOrthopedicsUrologyNeurosurgeryOphthalmologyCardiologyRadiologyGeneral SurgeryPlastic SurgeryPathologyCode 49186Code 49187Code 49188Code 49189Code 49190Code 64466Code 64467Code 64468Code 64469Code 64473Code 64474Code 86581Code 87513Code 87564Code 87594Code 87626Code 96041Code 90593Code 25448Code 53866Code 61715Code 81195Code 81558Code 82233Code 82234Code 83884Code 84393Code 84394Code 81515Code 51721Code 55881Code 55882Code 66683Code 92137Code 53865Code 60660Code 60661Code 38225Code 38226Code 38227Code 38228Code 15011Code 15012Code 15013Code 15014Code 15015Code 15016Code 15017Code 15018Code 76014Code 76015Code 76016Code 76017Code 76018Code 76019Code 93896Code 93897Code 93898Code 98000Code 98001Code 98002Code 98003Code 98004Code 98005Code 98006Code 98007Code 98008Code 98009Code 98010Code 98011Code 98012Code 98013Code 98014Code 98015Code 98016

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