CommercialBilling CodesHigh impact
ICD-10 Diagnosis Coding Requirements for ST/PT/OT effective 2/15/26
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, BCBSRI 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 procedures billed with the same diagnosis codes will also be denied.
Action Required
Before February 15, 2026: Billing team must update system rules to flag and prevent submission of PT/OT/ST claims with ICD-10 codes containing seventh character 'A'. Train providers to use appropriate seventh characters (D for subsequent encounter, S for sequela) for therapy services. Update encounter forms and EMR templates to remind therapists about diagnosis code requirements. Claims submitted with 'A' seventh character will be automatically denied.