We have completed our review of the January 2026 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 January 1, 2026. 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.

January 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) are covered and separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and for Commercial products: 

33882  35602  37255  37257  37259  37261  37264  37266  37268  37270  37272  37274  37276 37278            37281  37283  37285  37287  37289  37291  37293  37295  37297  37299  55707  55708 55709            55710  55711  55712  55713  55714  55715  55868  55869  63032  70471  70472  70473 75577            87494  87812  90481  91124  91125  92288  92930  92945

*Note: CPT code 87812 is replacing CPT code 87428

The following code(s) are covered but not separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and for Commercial products: 

90482  90483  90484  97007  97008  97009  98979  98984  98985  98986  99445  99470  1022T 1023T            1024T

The following code(s) are subject to medical review and are separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and for Commercial Products: 

52597  64567  64657  64658  64659  0989T  1014T  1015T  1019T  37254  37256  37258  37260

37263  37265  37267  37269  37271  37273  37275  37277  37280  37282  37284  37286  37288

37290  37292  37294  37296  37298  47384  81354  81524  87182  87183  87627  0601U 0605U

0606U 0607U 0608U 0609U 0610U 0613U

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

27458  27713  43889  52443  64728  0988T  0990T  0991T  0992T  0993T  0994T  0995T  0996T 0997T            0998T  0999T  1000T  1001T  1002T  1003T  1004T  1005T  1006T  1007T  1008T  1009T

1010T  1011T  1012T  1013T  1016T  1017T  1018T  1020T  1021T  1025T

The following code(s) are not covered for Professional and Institutional providers for Medicare Advantage Plans and not medically necessary for Professional and Institutional providers for Commercial products:

37262  37279  55877  62330  62331  64654  64655  64656  77436  77437  77438  77439

93145  93146  0600U 0602U 0603U 0604U 0611U 0612U

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

92628  92629  92631  92632  92634  92635  92636  92637  92638  92639  92641  92642