Summary
Two significant policy updates effective October 1, 2026: (1) Home health care therapy services (revenue codes 042X, 043X, 044X) now require specific therapy modifiers (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) appended to CPT codes, or claims will be denied; (2) Behavioral health collaborative care codes are no longer reimbursable for a comprehensive list of provider specialties including psychiatrists, psychologists, clinical social workers, and licensed counselors.
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What to do
by Oct 1, 2026 · 7 steps
01Billing team must update billing software to automatically append or require therapy service modifiers (GP, GO, GN) to all home health claims using revenue codes 042X, 043X, and 044X.
02Add validation rules to reject claims missing these modifiers before submission.
03Update provider and front desk documentation to remind clinicians of modifier requirements.
04Billing team must immediately identify all behavioral health collaborative care claims currently being submitted and cross-reference provider specialties against the ineligible list (psychiatrists, psychologists, LICSW, LMHC, LMFT, LBA, LCDP, CNS, BH NP, BH PA, psychiatric neurologists, child/adolescent psychiatrists).
05Create system edits to block reimbursement claims for these provider types on collaborative care codes.
06Notify affected providers of eligibility changes.
07Claims submitted on or after October 1, 2026 without compliant modifiers or from ineligible providers will be denied.
Original notice
Payment policy updates
bcbsri.com · Always check the source before changing claims.
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 / FacilitySNF Home Health Agency codingHighEffective Oct 1, 2026 · Physician / FacilityPayment policy updatesHighEffective Oct 1, 2026 · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list