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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Prior Auth · Physician / Facility · RI · Hematology, Oncology, Vascular Surgery +1 moreHigh impact

Medical policy updates

Act
by Jun 1, 2026
Effective date
Jun 1, 2026
Identified
Jun 19, 2026

Summary

Multiple medical policy updates effective June through August 2026 affecting prior authorization requirements, coverage determinations, and billing procedures across various specialties. Key changes include removal of prior authorization for several CPT codes, coverage status changes for autism services and biomarker testing, and new medical criteria for vascular procedures.

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What to do

by Jun 1, 2026 · 4 steps
01Billing team must update authorization requirements for blood product typing codes 0001U and 0084U to reference new medical policy instead of online tool.
02By July 1, 2026: Remove prior authorization for CPT codes 0408T-0411T, 0415T-0418T, and 0412T-0414T for Medicare Advantage plans only, and add prior authorization requirement for L5827.
03By August 1, 2026: Update billing system to reflect coverage changes for autism services (not covered for Medicare Advantage), biomarker testing codes with new coverage/prior auth status, prosthetic codes A8005/A8006 (not covered), and revised medical criteria for vascular embolization codes 37242/37243.
04Claims will be processed according to new coverage determinations.

Codes mentioned

3724237243A8005A8006L5827812318123281247813068135081418812278128381374813778138181383812258122681335813288134681355812198133881339

Original notice

Medical 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 →
January 2018MediumEffective Jan 1, 2018 · Provider UpdateMedical policy updatesHighEffective Sep 1, 2024 · Physician / FacilityMedical policy updatesMediumEffective May 1, 2025 · Physician / FacilityMedical policy updatesHighEffective Apr 1, 2025 · Physician / FacilityBrowse 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 changesHematologyOncologyVascular SurgeryPM&R (Physical Medicine & Rehab)Code 37242Code 37243Code A8005Code A8006Code L5827Code 81231Code 81232Code 81247Code 81306Code 81350Code 81418Code 81227Code 81283Code 81374Code 81377Code 81381Code 81383Code 81225Code 81226Code 81335Code 81328Code 81346Code 81355Code 81219Code 81338Code 81339

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