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Blue Cross Blue Shield of Rhode IslandAll Plans · Coverage · Provider Update · RI · Physical Therapy, Speech Therapy, Occupational Therapy +2 moreHigh impact

Payment policy updates

Effective date
Oct 1, 2026
Identified
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.

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What to do

Action · 11 steps
01BEFORE October 1, 2026.
02Billing 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.
03Add validation rules to reject claims missing or containing incorrect modifiers.
04Train billing and provider staff on modifier assignment.
05Immediately 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).
06Block these providers from receiving reimbursement for collaborative care codes effective October 1, 2026.
07Billing team must obtain updated pharmacy drug list from insurer and update billing system/claims processing rules.
08For Early Intervention Services: Update billing system to flag members with high-deductible plans and ensure cost-share is applied at point-of-service.
09Communicate changes to front desk and patient intake staff.
10Consequence: Claims submitted without required therapy modifiers will be DENIED.
11Claims from ineligible provider types for collaborative care will be DENIED.

Original notice

Payment policy updates
bcbsri.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
Payment policy updatesHighEffective Jan 1, 2027 · Physician / FacilityPayment policy updatesHighEffective Oct 1, 2026 · Physician / FacilityPayment Policy UpdatesHighEffective Oct 1, 2026 · Physician / FacilityPayment policy updatesHighEffective Sep 1, 2026 · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list

Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesPhysical TherapySpeech TherapyOccupational TherapyPsychiatryPharmacy

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