Summary
Blue Cross Blue Shield of Rhode Island's October 1, 2026 medical policy update changes several effective-December 1, 2026 rules for Medicare Advantage and commercial plans. The biggest moves are coverage changes for specific lab tests (several become not covered or not medically necessary, and others gain or lose prior authorization), a new covered diagnosis list for corneal topography, and coverage for two back pain procedures on Medicare Advantage plans only. Lab, imaging and procedure billing teams should update their tests and authorization workflows before December 1, 2026.
Get alerts when payers change rules like this one
We check Blue Cross Blue Shield of Rhode Island and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross Blue Shield of Rhode Island alertsPolicy Monitoring is free. No card required.
What to do
by Dec 1, 2026 · 13 steps
01Billing team and lab staff, update the lab and test fee and coverage references in charge entry and the prior authorization tracker.
02Biomarker Testing Mandate: for CPT 0017M, add prior authorization for Medicare Advantage and commercial members using the criteria in the policy; for 0009U, use the new criteria in the policy; for 0040U, use the LCD criteria available in the online authorization tool for participating providers; for 0063U, remove the prior authorization step, as the service will be covered.
03For 0618U, 0622U and 0627U, and the other listed codes in the notice, the notice states they will not be covered for Medicare Advantage and not medically necessary for commercial products, so stop scheduling or billing these tests for those members and tell ordering providers.
04Prior authorization is removed for the listed group, but the services remain not covered.
05Investigational Services: the 22 listed codes move to the Biomarker Testing Mandate policy with no change in coverage, so update the lab order references to that policy.
06The Polygenic Risk Score policy will cover only that testing.
07Corneal topography (CPT 92025): add the newly covered ICD-10-CM diagnoses in the eye care claim diagnosis entry for both Medicare Advantage and commercial members.
08The notice does not list the new diagnosis codes, so check the policy page for them.
09Back pain procedures: for Medicare Advantage, CPT 62330 and 62331 become covered, and CPT 64628 and 64629 use the LCD InterQual criteria in the online authorization tool; no commercial change.
10Gene expression profiling: CPT 81529 and 0090U move from prior authorization to not covered for Medicare Advantage and not medically necessary for commercial, so stop scheduling them for those members.
11DME: HCPCS L2221 keeps prior authorization for Medicare Advantage with criteria moved to the online tool, and is not medically necessary for commercial under the Microprocessor-Controlled Prostheses policy; L5615 keeps prior authorization for commercial with criteria moved to the online tool.
12Nucleic acid probe tests 0140U, 0141U and 0142U keep prior authorization, with criteria moved to the online tool.
13Radioembolization policy criteria are revised for both plan types.
Codes mentioned
920256233062331646286462981529L2221L5615
Original notice
Medical policy updates
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →CPT code changesHighEffective Jan 1, 2022 · Physician / FacilityPolicy updatesHighEffective Feb 1, 2024 · Physician / FacilityMedical policy updatesHighEffective Oct 1, 2025 · Physician / FacilityMedical policy updatesHighEffective Feb 1, 2026 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list