We have completed our review of the October 2025 CPT code changes, including any category II performance measurement tracking codes and category II temporary codes for emerging technology. These updates will be added to our claims processing system and are effective October 1, 2025. The list includes codes that have special coverage or payment rules for standard products. (Some employers may customize their benefits.) We have included codes for services that are:

• “Not Covered” – This includes services not covered in the main member certificate (e.g., covered as a prescription drug).
• “Not Medically Necessary” – This indicates services where there is insufficient evidence to support it.
• “Not Separately Reimbursed” – Services that are not separately reimbursed are generally included in payment for another service or are reported using another code and may not be billed to your patient.
• “Subject to Medical Review” – Preauthorization is recommended for commercial products and required for BlueCHiP for Medicare.
• “Invalid” – Use alternate procedure codes, such as a CPT or HCPCS code.
• “Medicare Lab Network” – Codes that are reimbursed to a hospital laboratory outside of the laboratory network, physicians, or urgent care center providers for BlueCHiP for Medicare.
• “Pending CMS determination” – For BlueCHiP for Medicare Category III codes.

Please submit your comments and concerns regarding coverage and payment designations to:

Email: Medical.Policy@bcbsri.org

Mail:   Blue Cross & Blue Shield of Rhode Island

Attention: Medical Policy, CPT Review

500 Exchange Street

Providence, Rhode Island 02903

Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them.

CPT is a registered trademark of the American Medical Association.

October 2025 CPT updates:

Please note: Coverage and/or payment rules for code(s) below may be subject to change for Medicare Advantage Plans and/or Commercial Products.

Additionally, coverage may vary for those Commercial Products that have opted out of the Biomarker Testing Mandate.

The following code(s) will be covered and separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial products:

0580U

The following code(s) will require prior authorization except when filed with ICD-10-CM code range F01-F99 and are separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial products:

0587U

The following code(s) will require prior authorization and are separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial products:

0575U 0576U 0577U 0578U 0579U 0581U 0582U 0583U 0584U 0585U 0586U 0588U 0589U

0590U 0591U 0592U 0593U 0594U 0595U 0596U 0597U 0598U 0599U