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Medical policy updates
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jun 19, 2026
Summary
Effective July 1, 2026, multiple policy changes include removing prior authorization for chronic liver disease testing (CPT 0344U), adding prior authorization requirements for tibial nerve stimulation, changing orthognathic surgery codes to use general prior authorization criteria instead of specialty-specific criteria, and updating various other testing and procedure requirements across Medicare Advantage and commercial plans.
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What to do
by Jul 1, 2026 · 6 steps
01Update billing system to remove prior authorization requirement for CPT 0344U (chronic liver disease testing) but note it will be non-covered/not medically necessary.
02Add prior authorization requirement for CPT 0587T (tibial nerve stimulation) for commercial plans.
03Remove prior authorization for Medicare CPT codes 0588T, 0589T, 0590T.
04Update all orthognathic surgery codes (21141-21209) to use general prior authorization criteria.
05Add diagnosis code edits for allergy testing, bacterial vaginosis testing, and biomarker codes.
06Update DME prior authorization processes for prosthetic codes L5827, L5841, L5926 to use InterQual criteria instead of BCBSRI medical policies.
Codes mentioned
8600386008815152114121142211432114521146211472115021151211542115521159211602118821193211942119521196211982119921206212082120985730875058750687507L5827L5841L5926
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 →Allergy TestingMediumEffective Aug 1, 2019 · Physician / FacilityPolicy updatesHighEffective Mar 1, 2023 · Physician / FacilityPolicy updatesHighEffective Apr 1, 2024 · Physician / FacilityMedical policy updatesHighEffective Feb 1, 2026 · 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 changesOral & Maxillofacial SurgeryPlastic SurgeryUrologyNeurologyGastroenterologyAllergy & ImmunologyOncologyPM&R (Physical Medicine & Rehab)Code 86003Code 86008Code 81515Code 21141Code 21142Code 21143Code 21145Code 21146Code 21147Code 21150Code 21151Code 21154Code 21155Code 21159Code 21160Code 21188Code 21193Code 21194Code 21195Code 21196Code 21198Code 21199Code 21206Code 21208Code 21209Code 85730Code 87505Code 87506Code 87507Code L5827Code L5841Code L5926