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Blue Cross Blue Shield of Rhode IslandCommercial · Billing Codes · Physician / Facility · RI · OB-GYN, PharmacyHigh impact

Payment policy updates

Effective date
Jan 1, 2027
Identified
Oct 31, 2026

Summary

BCBS Rhode Island issued multiple payment policy updates with staggered effective dates: pharmacy MPS lists updated (October 1, 2026—already effective), CPT 87494 (STI testing) added to preventive benefits (January 1, 2026—already effective), fee-based PCP attribution policy updated per state regulation (September 21, 2026 bulletin), and maternity/OB services billing fundamentally restructured from bundled to unbundled codes effective January 1, 2027. The OB policy change requires providers to bill individual E&M and delivery codes instead of global OB packages starting 2027.

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What to do

Action · 8 steps
01Before January 1, 2027: Billing team must transition OB/maternity billing workflows from bundled AMA/CPT codes to unbundled Evaluation and Management codes and delivery codes.
02Update billing system templates, encoder rules, and provider education materials to reflect the switch.
03Current bundled OB codes will be deleted on December 31, 2026.
04Verify current applicability of already-effective changes.
05Confirm pharmacy MPS list updates for Commercial and Medicare plans were implemented for October 1, 2026 effective date.
06Confirm CPT 87494 (STI testing) is active in preventive benefits systems for both Commercial and Medicare Advantage plans (effective January 1, 2026).
07Review fee-based PCP policy updates in compliance with September 21, 2026 Rhode Island OHIC Bulletin 2026-03 regarding attribution and PQIP participation.
08Consult policy details and FAQ section for code mapping and billing examples.

Codes mentioned

87494

Original notice

Payment policy updates
bcbsri.com · Always check the source before changing claims.
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Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
Payment policy updatesHighEffective Oct 1, 2026 · Physician / FacilityPayment Policy UpdatesHighEffective Oct 1, 2026 · Physician / FacilityPayment policy updatesHighEffective Oct 1, 2026 · Provider UpdatePayment 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 changesOB-GYNPharmacyCode 87494

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