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, 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' (typically indicating initial encounter for injury). 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 systems to flag and prevent submission of PT/ST/OT claims with ICD-10 codes containing seventh character 'A'. Train providers to use appropriate diagnosis codes for therapy services that don't indicate initial encounters. Review and modify encounter forms and EMR templates to guide proper diagnosis coding. Claims submitted with 'A' character diagnosis codes will be automatically denied.