Prior authorization via web-based tool for Durable Medical Equipment (DME)

Effective June 1, 2025, for commercial products, HCPCS code E2513 will change from being reviewed using BCBSRI medical necessity policy criteria to being reviewed utilizing the medical criteria in the online authorization tool. There has been no change to Medicare advantage plans. For additional information related to this policy, please click here.

CA 125

Effective June 1, 2025, ICD-10 code range R19.01-R19.04 will be added to the list of covered ICD-10 codes for CPT 86304 for Medicare Advantage plans and commercial products. For additional information related to this policy, please click here.

Human Leukocyte Antigen Testing Mandate 

Effective June 1, 2025, CPT codes 81370 through 81383, 86812, 86817, 86821, 86825, 86826, and 86829 through 86835 will be added to this policy for Medicare Advantage plans and commercial products and will require Modifier 32 when performed as part of this Rhode Island State mandate. These codes will continue to be covered for both Medicare Advantage plans and commercial products with a limit of one test per lifetime when applicable to this mandate. For additional information related to this policy, please click here.

Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease        

Effective May 1, 2025, ICD-10 codes E10.A0 – E10.A2, E88.810 and E88.82 will be added to the list of covered diagnoses for CPT codes 83700, 83701 and 83704 for Medicare Advantage Plans and Commercial Products. ICD-10 codes T45.AX1A - T45.AX5S and Z92.26 will be added to the list of covered diagnoses for CPT code 82610 for Medicare Advantage Plans and Commercial Products. For additional information related to this policy, please click here.