Cranial Orthoses (Adjustable) for Positional Plagiocephaly and Craniosynostoses
Effective December 1, 2025, the Policy Statement section of the policy will be updated to provide clarity for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases
Effective November 1, 2025, prior authorization will be removed from CPT codes 81450 and 81451, which will be changed to covered for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.
Cardiac Hemodynamic Monitoring
Effective November 1, 2025, CPT/HCPCS codes 33289, 93264, and G0555 will change to covered for Medicare Advantage plans. No other changes to policy. For additional details related to this policy, please click here.
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Effective November 1, 2025, CPT code 33340 will continue to require prior authorization; however, the medical criteria will change from medical policy, Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation to the medical criteria found in the online authorization tool for participating providers for commercial products. There will be no other changes in this medical policy. For additional details related to this policy, please click here.
Prior Authorization via Web Based Tool for DME
Effective November 1, 2025, CPT code L5615 will continue to require prior authorization; however, the medical criteria will change from medical policy, Microprocessor-Controlled Prostheses for the Lower Limb to the medical criteria found in the online authorization tool for participating providers for Medicare Advantage plans.
Effective December 1, 2025, CPT code L2006 will continue to require prior authorization; however, the medical criteria will change from medical policy, Medical Necessity, to the medical criteria found in the online authorization tool for participating providers for commercial products.
Additionally, HCPCS codes K0898, K0812, E0983, E0984 were updated as a correction in the policy grid to show utilization of the online authorization tool for the medical criteria for commercial products.
There will be no other changes in this medical policy. For additional details related to this policy, please click here.
Glucose Monitors – Continuous
Effective October 1, 2025, Dexcom and Abbott FreeStyle Libre branded non-implantable continuous glucose monitoring devices obtained from a retail pharmacy will no longer require authorization for commercial products through BCBSRI’s Pharmacy Benefit Management Program vendor. There will be no other changes in this medical policy. For additional details related to this policy, please click here.
Ambulance Services – Ground
There will be a correction to the previous notice in the September 2025 Provider Update. Effective December 1, 2025, Modifier QL is applicable for HCPCS codes A0428 and A0429 only. For additional details related to this policy, please click here.