Medicare AdvantageCoverageHigh impact
Additional CPT® Code Changes January 2025
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Urology, Neurosurgery +5 more·Physician / Facility
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross & Blue Shield of Rhode Island has implemented new CPT code coverage and payment rules effective January 1, 2025. The changes include new covered codes, prior authorization requirements, and different coverage rules between Medicare Advantage and Commercial plans for dozens of procedures.
Action Required
By January 1, 2025: Billing team must update system to require prior authorization for specified codes including 25448, 53866, 61715, and all Category III codes listed (0901T-0947T). Configure different authorization rules for Medicare Advantage vs Commercial plans. Update billing software to flag codes requiring covered ICD-10 codes for 81515. Configure vaccine code 90593 as pharmacy benefit for Medicare Advantage but covered for Commercial. Update encounter forms to reflect new coverage differences between plan types.