Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·Endocrinology, Gastroenterology, Oncology +5 more·Physician / Facility
Effective date
Feb 1, 2026
We identified it
Jun 19, 2026
Summary
Multiple policy updates are rolling out between February-April 2026, including InterQual criteria changes for molecular diagnostics and procedures, fertility coverage modifications, removal of prior authorization for several genetic testing and continuous glucose monitoring codes, and updated diagnosis code lists for various services.
Action Required
By February 1, 2026: Update InterQual authorization tool access for molecular diagnostics criteria including Alzheimer's Disease and DPYD Testing. By March 1, 2026: Remove prior authorization requirements for CPT 0446T, 0447T, 0448T (continuous glucose monitoring) and update system for renal RFA/cryoablation procedures. By April 1, 2026: Major updates required - remove prior authorization for multiple genetic testing codes (81315, 81316, 81345 with specific diagnoses), update fertility coverage criteria removing EmbryoGlue coverage, add covered diagnosis codes for acute hepatitis panel (80074), and implement new medical necessity criteria for back pain procedures (64628/64629) and sleep apnea treatments (64568). Billing team must update system edits, authorization requirements, and covered diagnosis lists across all affected codes.