CommercialCoverageHigh impact
Payment Policy Updates
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' (typically indicating initial encounter for injury/trauma). Modality procedures billed on the same date with the same diagnosis will also be denied.
Action Required
Before February 15, 2026: Billing team must update claim review processes to identify and flag all PT, OT, and ST claims with ICD-10 codes containing seventh character 'A'. Train providers to use appropriate alternative diagnosis codes or modifiers if available. Update billing software edits to prevent submission of these claims to avoid automatic denials.