Medicare AdvantageBilling CodesHigh impact
Payment Policy Updates
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Hematology·Physician / Facility
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple policy updates effective January 1, 2025: CAR-T therapy temporary codes (0537T-0540T) replaced with permanent CPT codes (38225-38228) but are not separately reimbursed, telemedicine code changes for Medicare Advantage and Commercial plans, and extensive list of codes added to non-reimbursable (NSR) list. Additional changes include new DME-only codes and modifier updates.
Action Required
By January 1, 2025: Billing team must update system to replace CAR-T therapy codes 0537T-0540T with new CPT codes 38225-38228 and submit directly to CMS (not separately reimbursed). Remove telemedicine codes 99441, 99442, 99443 from Medicare Advantage billing and code 96040 from all plans. Add code 96041 for Commercial plans only. Update system to deny all newly added NSR codes as non-reimbursable. Configure DME codes E1803-E1829 to process only for DME providers. Replace modifier JG with TB. Update encounter forms and train staff on code changes to prevent claim denials.