We have completed our review of the July 2026 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 July 1st, 2026. 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” – 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.

July 2026 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 for both Opt-In and Opt-Out groups: 

0636U   0637U   0638U   0639U

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

90616    90639    1051T    1052T    1053T

The following code(s) will be subject to medical review and will be separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products for Opt-In groups; and will be not covered for Commercial Product Opt-Out groups for Professional and Institutional providers: 

0631U   0632U   0633U   0634U   0635U   0640U   0641U   0642U   0643U   0644U   0645U   0646U   0647U

0648U   0649U   0650U   0651U   0652U   0653U   0654U   0655U   0656U   0657U   0658U   0659U

The following code(s) will be subject to medical review and will be separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and will be not medically necessary for Commercial Products for Professional and Institutional providers:

1026T    1027T    1036T    1037T    1038T    1040T    1050T

The following code(s) will be not separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products: 

1028T    1029T    1030T    1031T    1032T    1033T    1034T    1035T    1039T    1041T    1042T    1043T    1044T

1045T    1046T    1047T    1048T    1049T