Medicare AdvantageBilling CodesHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island has updated CPT codes effective April 1, 2026, with specific coverage rules for new Category II and Category III codes. Multiple new codes have varying coverage status including covered, subject to medical review, or not covered depending on plan type and opt-in/opt-out status.
Action Required
By April 1, 2026: Billing team must update system with new CPT code coverage rules - verify patient plan type (Medicare Advantage vs Commercial) and opt-in/opt-out status before billing codes 0614U-0630U. Set up prior authorization requirements for codes 0614U, 0616U, 0617U, 0619U, 0620U, 0623U-0626U, 0628U-0629U for applicable plans. Update encounter forms and train staff on coverage variations by plan type to prevent claim denials.