Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis

Effective May 1, 2025, ICD-10 code B37.9 will be added to the list of covered ICD-10 codes for CPT codes 81513 and 81514 for Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.

Next Generation Sequencing for Solid Tumors                 

Effective May 1, 2025, CPT codes 0329U and 0379U will be added to the medical policy, Next Generation Sequencing for Solid Tumors. CPTs 0329U and 0379U will continue to require prior authorization and may be considered medically necessary for both Medicare Advantage plans and commercial products when the medical criteria are met in the policy. There will be no other changes to this policy. For additional details related to this policy, please click here.

Home Prothrombin Time Monitoring

Effective April 1, 2025, ICD-10 codes I26.03 and I26.95 will be added to the list of covered ICD-10 codes for HCPCS codes G0248, G0249, G0250 and CPT codes 93792 and 93793 for Medicare Advantage Plans and Commercial Products. For additional details related to this policy, please click here. 

Transcutaneous Electrical Nerve Stimulation and Transcutaneous Afferent Patterned Stimulation

Effective April 1, 2025, HCPCS codes E0734 and A4542 will change from not covered to requiring prior authorization for Medicare Advantage Plans utilizing the medical criteria in the online portal for participating providers. For additional details related to this policy, please click here.

Minimal Residual Disease Testing for Cancer                            

Effective April 1, 2025, CPT code 0364U, Colonoseq, ICD-10 codes C83.10 – C83.19 will be added to the list of covered ICD-10 codes for Medicare Advantage Plans and Commercial Products and will be applicable retroactive to 7/11/2024. Effective 4/01/2024, Guardant Reveal, CPT code 81479, will continue to require prior authorization for Medicare Advantage Plans and recommended for Commercial Products and will be approved when the medical criteria in this policy has been met. For additional details related to this policy, please click here.

Prior Authorization Via Web-Based Tool for Procedures 
Removal of Implantable Devices
Effective May 1, 2025, CPT codes 0824T and 0825T will change from being covered for Medicare Advantage Plans to requiring prior authorization through the Cardiology and Radiology Management Program. For Commercial Products, prior authorization will continue to be recommended but will be obtained through the Cardiology and Radiology Management Program instead of through BCBSRI. For additional details related to these policies, please click their appropriate link.

Prior Authorization Via Web-Based Tool for Procedures

Removal of Implantable Devices 

Laboratory Tests Post Transplant and for Heart Failure

Code correction made to CPT 0493U: 

Effective March 1, 2025, CPT 0493U will not change to not covered for Medicare Advantage Plans and not medically necessary for Commercial Products. CPT 0493U will revert back to requiring Prior Authorization for both Medicare Advantage Plans and Commercial Products based on the medical criteria in the policy. No other corrections made to policy. For additional details related to this policy, please click here.