Laboratory Testing Investigational Services

Effective December 1, 2026, CPT codes 0355U, 0362U, 0365U, 0366U, 0367U, 0371U, 0372U, 0376U, 0377U, 0384U, 0385U, 0390U, 0405U, 0406U, 0410U, 0415U, 0600U, 0602U, 0603U, 0604U, 0611U and 0612U will be removed from this policy and will be addressed only in medical policy, Biomarker Testing Mandate. These CPT codes will have no change in coverage; will remain not covered for Medicare Advantage plans and not medically necessary for commercial products. The title of this policy will change to Polygenic Risk Score as it will now only address Polygeneic Risk Score testing with no change in coverage. This testing will continue to be not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here.

Corneal Topography, Computer Assisted Corneal Topography, Photokeratoscopy     

Effective December 1, 2026, there will be additional covered ICD-10-CM codes added to the list of covered diagnoses for Medicare Advantage plans and commercial products for CPT code 92025. For additional details related to this policy, please click here.

Biomarker Testing Mandate

Effective December 1, 2026: 

• CPT code 0017M: Prior authorization will be added to Medicare Advantage plans and commercial products using the criteria in this policy.
• CPT code 0009U: Medical necessity criteria will change to the criteria in this policy for Medicare Advantage plans and commercial products.
• CPT code 0040U: Medical necessity criteria will change to LCD criteria and will be available in the online authorization tool for participating providers for Medicare Advantage plans and commercial products.
• CPT code 0063U: Prior authorization will be removed from Medicare Advantage plans and commercial products; service will be covered.
• CPT codes 0618U, 0622U, 0627U: Services will be not covered for Medicare Advantage plans and not medically necessary for commercial products.
• For the following CPT codes, prior authorization will be removed from Medicare Advantage plans and commercial products; service will be not covered for Medicare Advantage plans and not medically necessary for commercial products:
  • 0575U, 0579U, 0592U, 0616U, 0617U, 0619U, 0620U, 0623U, 0624U, 0625U, 0626U, 0629U, 0631U, 0634U, 0644U, 0645U, 0646U, 0647U, 0650U, 0652U, 0653U, 0654U, 0655U, 0657U, 0658U, 0659U

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

Minimally Invasive Procedures for Back Pain

For Medicare Advantage plans only:

Effective December 1, 2026, CPT codes 62330/62331 will change from not covered for Medicare Advantage plans to covered for Medicare Advantage plans. No change to commercial products. 

Additionally, effective December 1, 2026, CPTs 64628/64629 will have a medical necessity criteria change from using the criteria in this BCBSRI policy to using the Medicare-compliant LCD InterQual criteria which will be available in the online authorization tool for participating providers for Medicare Advantage plans. No changes to commercial products. For additional details related to this policy, please click here.

Radioembolization for Primary and Metastatic Tumors of the Liver

Effective December 1, 2026, for Medicare Advantage plans and commercial products, there will be a revision to the medical necessity criteria in the policy. There will be no other changes to this policy. For additional details related to this policy, please click here.

Gene Expression Profiling for Cutaneous Melanoma 

Effective December 1, 2026, CPTs 81529/0090U will change from prior authorization to not covered for Medicare Advantage plans and not medically necessary for commercial products. For additional details related to this policy, please click here.

Prior Authorization for Durable Medical Equipment (DME) 

• Effective December 1, 2026, for Medicare Advantage plans, HCPCS code L2221 will be continue to require prior authorization, however, the medical criteria source will move from the Microprocessor-Controlled Prostheses for the Lower Limb Medical Policy to utilizing the medical necessity criteria available in the online authorization tool for participating providers for Medicare Advantage plans.
• Effective December 1, 2026, L2221 will be added to the Microprocessor-Controlled Prostheses for the Lower Limb Medical Policy where it will be not medically necessary for commercial products. Please refer to the draft medical policy for details.
• Effective December 1, 2026, L5615 will be continue to require prior authorization, however, the medical criteria source will move from the Microprocessor-Controlled Prostheses for the Lower Limb Medical Policy to utilizing the medical necessity criteria available in the online authorization tool for participating providers for commercial products. For additional details related to this policy, please click here.

Identification of Microorganisms Using Nucleic Acid Probes

Effective December 1, 2026:

• CPT codes 0140U, 0141U, and 0142U 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, Biomarker Testing Mandate.
• There are no other changes for this medical policy for Medicare Advantage plans or commercial products.

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

Microprocessor-Controlled Prostheses for the Lower Limb

Effective December 1, 2026, there will be a Medicare criteria change from BCBSRI (New Tech/Med Nec) to LCD in IQ. L2221 will be added to the Microprocessor-Controlled Prostheses for the Lower Limb Medical Policy where it will be not medically necessary for commercial products. For additional details related to this policy, please click here.