CommercialBilling CodesHigh impact
ICD-10 Diagnosis Coding Requirements for ST/PT/OT effective February 15, 2026
Blue Cross Blue Shield of Rhode Island·RI · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Physician
Effective date
Feb 15, 2026
We identified it
Jun 19, 2026
Summary
Effective February 15, 2026, BCBS Rhode Island will deny all physical therapy, speech therapy, and occupational therapy claims that include any ICD-10 diagnosis code requiring the seventh character 'A' (initial encounter for fracture). Modality procedure codes billed on the same date with the same diagnosis will also be denied.
Action Required
By February 15, 2026: Billing team must update claim review processes to identify and avoid submitting PT/ST/OT claims with ICD-10 codes requiring seventh character 'A'. Train therapists to use appropriate diagnosis codes (such as subsequent encounter codes with 'D' or sequela codes with 'S') for ongoing therapy services. Update billing software edits to flag these code combinations before submission to prevent automatic denials.