Medical policy updates
BlueCross BlueShield of Rhode Island's November 2026 update changes prior authorization and coverage for many lab, genetic and imaging services, most of them effective January 1, 2027 for Medicare Advantage and commercial plans, including removing prior authorization for many biomarker testing codes and adding prior authorization for CPT 0154U. It also adds a physical and occupational therapy review after the 14th visit per episode for fully funded commercial plans at renewal on or after January 1, 2027, and it recorded a November 1, 2026 change that keeps the online tool criteria for shoulder replacement codes while the new draft policy is on hold.