We have completed our review of the April 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 April 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.

April 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 codes are covered and separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products opt-in groups, and are not covered for Commercial Products opt-out groups:

0618U 0622U 0627U

The following codes are covered and separately reimbursed for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products for both opt-in and opt-out groups: 

0615U 0621U

The following codes are subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products opt-in groups, and are not covered for Commercial Products opt-out groups:

0614U 0616U 0617U 0619U 0620U 0623U 0624U 0625U 0626U 0628U 0629U

The following codes are not covered for Professional and Institutional providers for Medicare Advantage Plans and not medically necessary for Professional and Institutional providers for Commercial Products opt-in groups, and are not covered for Commercial Products opt-out groups:

0630U