All PlansCoverageHigh impact
Payment policy updates
Blue Cross Blue Shield of Rhode Island·RI · Physical Therapy, Speech Therapy, Occupational Therapy +2 more·Provider Update
Effective date
Oct 1, 2026
We identified it
Sep 1, 2026
Summary
This policy package contains four separate updates effective October 1, 2026: (1) Home Health Care Services now require therapy service modifiers (GP, GO, GN) appended to revenue codes 042X, 043X, 044X or claims will be denied; (2) Behavioral Health Integration/Collaborative Care services are now restricted—12 provider types (psychiatrists, psychologists, LCSWs, LMHCs, LMFTs, LBAs, LCDPs, CNS, BH NPs, BH PAs, psychiatric neurologists, child/adolescent psychiatrists) are ineligible for reimbursement; (3) Early Intervention Services cost-sharing rules updated for high-deductible plans; (4) Pharmacy drug list updated for post-claim review. Immediate action required on modifier enforcement and provider eligibility.
Action Required
BEFORE October 1, 2026: (1) Billing team must update billing system to REQUIRE therapy service modifiers (GP, GO, GN) for all home health claims using revenue codes 042X, 043X, or 044X. Add validation rules to reject claims missing or containing incorrect modifiers. Train billing and provider staff on modifier assignment. (2) Immediately review provider roster and credentialing records—identify any of the 12 ineligible provider types (psychiatrists MD/DO, psychiatric neurologists, child/adolescent psychiatrists, CNS, BH NPs, BH PAs, psychologists PhD/PsyD, LCSWs, LMHCs, LMFTs, LBAs, LCDPs). Block these providers from receiving reimbursement for collaborative care codes effective October 1, 2026. (3) Billing team must obtain updated pharmacy drug list from insurer and update billing system/claims processing rules. (4) For Early Intervention Services: Update billing system to flag members with high-deductible plans and ensure cost-share is applied at point-of-service. Communicate changes to front desk and patient intake staff. Consequence: Claims submitted without required therapy modifiers will be DENIED. Claims from ineligible provider types for collaborative care will be DENIED.