We have completed our review of the October 2025 current procedural terminology (CPT) including any category II performance measurement tracking codes and Category III temporary codes for emerging technology. These updates will be added to our claims processing system and are effective October 1st, 2025. The lists include 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 “for Commercial and “Not Covered” for Medicare Advantage Plan – this indicates services where there is insufficient evidence to determine the effects of the technology on health outcomes.  
• “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 Medicare Advantage Plans. 
• “Individual Consideration review”- services that require supporting documentation filed with the claim for review.

• “Use Alternate Code”- services that require the use of an alternate code that is addressed in an existing policy.

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

  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