Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Ophthalmology, Cardiology·Physician / Facility
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple medical services are experiencing coverage and prior authorization changes effective April 1, 2025, including corneal topography becoming covered with specific diagnoses, new prior auth requirements for certain cardiology and genetic testing procedures, and changes to DME equipment authorization requirements.
Action Required
By March 31, 2025: Billing team must update system to require prior authorization for CPT codes 0862T, 0863T, 0865T using Evicore (1-888-233-8158). Update encounter forms to require specific ICD-10 codes for CPT 92025 and 0038U or claims will be denied. Remove prior auth requirements for HCPCS E1802 (commercial only). Add prior auth requirement for E0676 (Medicare Advantage only). Update genetic testing codes 81275, 81276, 81308 to covered status and implement specific diagnosis code requirements for multiple genetic testing codes.