Medicare AdvantageCoverageHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oral & Maxillofacial Surgery, Urology, Oncology +3 more·Physician / Facility
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple coverage improvements effective January 1, 2025, including removal of prior authorization requirements for TMJ arthrotomy (CPT 21010) and prostate cancer hydrogel spacer procedures (CPT 55874), plus coverage expansion for genetic testing codes and other services across Medicare Advantage and commercial plans.
Action Required
By January 1, 2025: Billing team must update system settings to remove prior authorization requirements for CPT 21010 (TMJ arthrotomy) and CPT 55874 (hydrogel spacer for prostate radiotherapy) for all plans. Update billing software to mark CPT 0392U and CPT 81490 as covered services. Replace incorrect CPT 93037 with CPT 97037 in low-level laser therapy billing templates. Update encounter forms and staff training materials to reflect these coverage changes.