Prior Authorization Legislation Takes Center Stage at Joint Hearing on Health Care Affordability
A joint hearing held on Jan. 22 by the U.S. House of Representatives Energy & Commerce Subcommittee on Health and the Ways and Means Committee hosted...
1 min read
On March 13, the Centers for Medicare and Medicaid Services released updates for CPT and Healthcare Common Procedure Coding System (HCPCS) codes.
CPT code G0567 was added to the national HCPCS file with an effective date of April 1, 2025. Medicare Administrative Contractors (MACs) do not need to manually add this code to the HCPCS file. MACs are instructed to contractor-price CPT code G0567 (where applicable) until the annual Clinical Laboratory Public Meeting addresses it in June or July 2025.
New Proprietary Laboratory Analysis codes also do not need to be manually added to the HCPCS file but should be MAC-priced (where applicable) until they are nationally priced and undergo the Clinical Laboratory Fee Schedule annual payment determination process. Tables are available for viewing the additional new and deleted codes effective April 1, 2025.
The following HCPCS codes were discontinued on Jan. 1, 2025: 0346U, 0352U, 0380U, 0428U, 0448U, and 0456U. Additionally, HCPCS codes 0167U and 0396U were discontinued on Oct. 1, 2024.
The following HCPCS codes were added on Jan. 1, 2025: 81195, 81515, 81558, 82233, 82234, 83884, 84393, 84394, 86581, 87513, 87564, 87594, 87626, and 0521U through 0530U.
Additionally, HCPCS codes 0476U through 0520U were added on Oct. 1, 2024, and HCPCS code 0020M was added on July 1, 2024. All are subject to Clinical Laboratory Improvement Amendments edits.
Sources:
Payer Update for Blue Cross Blue Shield New Jersey
TELCOR has identified ongoing processing challenges with BCBS New Jersey that laboratories should be aware of. When claims require medical records,...
Payer Update for BCBS Nebraska
TELCOR has identified a recent process change with BCBSNebraska impacting payment timelines. As of November 1, 2025, BCBSNE adjustedits payment...