Allergy Testing

Effective July 1, 2026, CPT codes 86003 and 86008 will continue to be covered when filed with a covered diagnosis with additional ICD-10-CM codes for commercial products only. There will be no other changes. For additional details related to this policy, please click here. 

Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis               

Effective July 1, 2026, CPT code 81515 will continue to be covered when filed with a covered diagnosis with additional ICD-10-CM codes for Medicare Advantage plans and commercial products. There will be no other changes. For additional details related to this policy, please click here.

Next Generation Sequencing for Solid Tumors 

Effective July 1, 2026, CPT codes 0244U, 0329U, 0334U, 0379U, and 0391U will continue to require prior authorization; however, the medical criteria will move from this policy to being available in the online authorization tool for participating providers for Medicare Advantage plans and commercial products. Coverage guidance will be available in the medical policy Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA). For additional details related to this policy, please click here.

Noninvasive Techniques for the Evaluation and Monitoring of Patients with Chronic Liver Disease

Effective July 1, 2026, for CPT 0344U, the prior authorization requirement will be removed for both Medicare Advantage plans and commercial products. Effective July 1, 2026, CPT code 0344U will be added to the medical policy Noninvasive Techniques for the Evaluation and Monitoring of Patients with Chronic Liver Disease, where it will be not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here.

Orthognathic Surgery

Effective July 1, 2026, the following CPT codes: 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206 ,21208, and 21209 will no longer utilize the medical criteria found in the Orthognathic Surgery medical policy, for both Medicare Advantage plans and commercial products. The codes will continue to require prior authorization for Medicare Advantage plans and commercial products. Coverage guidance will be available in the medical policy Prior Authorization of Services, Treatments or Procedures. For additional details related to this policy, please click here.

Injectable Bulking Agents for Urinary and Fecal Incontinence

Effective July 1, 2026 we have added 0963T to this policy and changed Medicare coverage from requiring prior authorization to not covered. For additional details related to this policy, please click here.

Percutaneous and Subcutaneous Tibial Nerve Stimulation

Effective July 1, 2026, we are adding prior authorization to code 0587T for commercial criteria. Medicare is changing from medical necessity to the criteria in this policy and removing prior authorization for Medicare for codes 0588T, 0589T, and 0590T. For additional details related to this policy, please click here.

Biomarker Testing Mandate

Effective July 1, 2026, the Biomarker Testing Mandate policy will be revised to incorporate all content from the following two policies: 

• Genetic Testing Services
• Proprietary Laboratory Analyses (PLA)/Multianalyte Assays with Algorithmic Analyses (MAAA)

Additionally, diagnosis editing will apply to the following codes:

• CPT code 85730: A covered diagnosis edit will be applied to commercial products.
• CPT codes 87505, 87506, and 87507: A covered diagnosis edit will be applied to Medicare Advantage plans and commercial products.

For additional details related to this policy, please click here.

Prior Authorization for Durable Medical Equipment (DME) 

HCPCS L5827: Criteria source will change from BCBSRI Medical Policy titled Microprocessor-Controlled Prostheses for the Lower Limb to InterQual criteria (for Commercial) and InterQual Noridian LCD criteria (for Medicare Advantage Plans) and will be available in the online authorization tool for participating providers for Medicare Advantage Plans and Commercial Products.  

• HCPCS L5841: Criteria source will change from BCBSRI Medical Policy titled Medical Necessity to InterQual and will be available in the online authorization tool for participating providers for Commercial Products.  

HCPCS L5926: For Medicare, criteria source will change from BCBSRI Medical Policy titled New Technology and Miscellaneous Services to using the InterQual, Noridian LCD. For Commercial, code will change from being not medically necessary in the Miscellaneous Services policy to requiring Prior Authorization and the criteria sourced will be InterQual will be available in the online authorization tool for participating providers for Commercial Products. 

For additional details related to this policy, please click here.