Medicare AdvantageCoverageHigh impact
Additional CPT® Code Changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jul 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated CPT code coverage and payment rules for July 2026, affecting dozens of new codes with varying coverage levels including covered services, medical review requirements, and non-covered services depending on plan type. The changes include new laboratory codes (0636U-0659U), vaccine codes (90616, 90639), and Category T codes with different rules for Medicare Advantage vs Commercial products.
Action Required
By July 1, 2026: Billing team must update system to reflect new CPT code coverage rules - codes 0636U-0639U, 90616, 90639, 1051T-1053T are covered and separately reimbursed; codes 0631U-0659U require medical review/preauthorization for covered plans but are not covered for Commercial Opt-Out groups; codes 1026T, 1027T, 1036T-1038T, 1040T, 1050T require medical review for Medicare Advantage only and are not medically necessary for Commercial; codes 1028T-1049T are not separately reimbursed. Update billing software rules and train staff on plan-specific coverage differences.