CommercialCoverageHigh impact
Payment Policy Updates
Blue Cross Blue Shield of Rhode Island·RI · Physical Therapy, Occupational Therapy, Dentistry +3 more·Physician / Facility
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island updated multiple payment policies with key changes including denial of PT/ST/OT claims with ICD-10 codes requiring 7th character 'A' starting Feb 15, 2026, new preventive imaging coverage for screening follow-ups, and updated hearing aid coverage codes effective Jan 1, 2026.
Action Required
By February 15, 2026: Billing team must update system to deny PT/ST/OT claims with ICD-10 codes requiring 7th character 'A' - claims will be automatically denied. By January 1, 2026: Update billing rules to process CPT codes 76641, 76642, 77049 as preventive benefit with $0 cost share when filed with Z12.31 or Z12.39 diagnosis codes for commercial in-network members only. Update encounter forms for dental providers to use Z01.818 for pre-kidney transplant and pre-heart valve surgery E&M visits. Replace deleted hearing aid codes with new detailed code list and update hearing aid coverage rules for commercial vs Medicare Advantage plans.