Medicare AdvantagePrior AuthMedium impact
New policy
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Hematology·Physician / Facility
Effective date
Jun 1, 2023
We identified it
Jun 19, 2026
Summary
A new policy for Minimal Residual Disease Testing for Cancer becomes effective June 1, 2023, establishing medical necessity criteria for CPT code 0364U. For Medicare Advantage plans, this code will be reviewed under the new policy instead of the Genetic Testing Services policy. For commercial products, CPT 0364U changes from 'not medically necessary' to requiring prior authorization.
Action Required
By June 1, 2023: Billing team must update system to require prior authorization for CPT code 0364U for commercial plans. Update encounter forms to remind providers that this code now requires prior auth for commercial products and will be reviewed under new medical necessity criteria for Medicare Advantage plans instead of genetic testing policy. Ensure providers understand the new medical necessity criteria to avoid claim denials.