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Medicare AdvantagePrior AuthHigh impact

Additional CPT® Code Changes January 2025

Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Urology, Neurosurgery +6 more·Physician / Facility
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Days to comply

Summary

Blue Cross Blue Shield of Rhode Island has updated CPT code coverage and prior authorization requirements for January 2025, affecting dozens of new codes with different rules for Medicare Advantage versus Commercial plans. Many new Category III codes now require prior authorization for Medicare Advantage but are deemed not medically necessary for Commercial products.

Action Required

Action needed
By January 1, 2025: Billing team must update system with new CPT code coverage rules for BCBS Rhode Island. Set up prior authorization requirements for Medicare Advantage plans for codes 25448, 53866, 61715, 81195, 81558, 82233, 82234, 83884, 84393, 84394, 0521U-0530U, 0910T, 0919T-0922T, 0942T, 0943T, and all 0901T-0947T codes. Configure system to deny billing of codes 53865, 60660, 60661 for all plans. Update encounter forms to flag codes requiring prior auth and inform providers that many Category III codes are not covered for Commercial products but require prior auth for Medicare Advantage.

Affected Billing Codes

49186
49187
49188
49189
49190
64466
64467
64468
64469
64473
64474
86581
87513
87564
87594
87626
96041
90593
25448
53866
61715
81195
81558
82233
82234
83884
84393
84394
81515
51721
55881
55882
66683
92137
53865
60660
60661
38225
38226
38227
38228
15011
15012
15013
15014
15015
15016
15017
15018
76014
76015
76016
76017
76018
76019
93896
93897
93898
98000
98001
98002
98003
98004
98005
98006
98007
98008
98009
98010
98011
98012
98013
98014
98015
98016