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CPT code changes for January 2025

Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Neurosurgery, Urology +5 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 payment rules effective January 1, 2025. The changes include new codes requiring prior authorization, codes with different coverage between Medicare Advantage and Commercial plans, and codes that are covered but not separately reimbursed.

Action Required

Action needed
By January 1, 2025: Billing team must update billing system to require prior authorization for codes 25448, 53866, 61715, 81195, 81558, 82233, 82234, 83884, 84393, 84394, 0521U-0530U, 0910T, 0919T-0922T, 0942T, 0943T for both Medicare Advantage and Commercial plans. Update system to require cardiology/radiology vendor prior auth for codes 0913T-0918T, 0923T, 0933T. Configure billing rules to show codes 38225-38228, 15011-15018, 76014-76019, 93896-93898, 98000-98016 as covered but not separately reimbursed. Train staff on different coverage rules between Medicare Advantage and Commercial plans for multiple codes. Claims without proper prior authorization will be denied.

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