CommercialPrior AuthHigh impact
Policies related to the BIOMARKER Testing Mandate, effective January 1, 2024
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Pathology, OB-GYN +6 more·Physician / Facility
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI has implemented a Rhode Island Biomarker Testing Mandate effective January 1, 2024, creating numerous new genetic testing policies and changing coverage status for many biomarker tests from 'not medically necessary' to 'prior authorization required' for commercial products. Multiple CPT codes across cancer testing, genetic disorders, and molecular diagnostics now require prior authorization instead of automatic denial.
Action Required
Immediately (effective January 1, 2024): Billing team must update prior authorization requirements for 40+ CPT codes related to genetic and biomarker testing. Key changes include updating billing software to require prior auth for previously denied codes like 0153U, 0045U, 81554, 81529, 0089U, 0090U, and multiple prostate cancer biomarker codes (81479, 81541, 81542, 0047U, 81313, 81539, 81551, 0005U, 0113U, 0339U) for commercial products. Review full policy text at BCBSRI.com under Medical Policy section for complete coverage criteria. Claims submitted without proper prior authorization will be denied.