Medicare AdvantageCoverageHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·Cardiology, Wound Care, Allergy & Immunology +7 more·Physician / Facility
Effective date
Feb 1, 2026
We identified it
Jun 19, 2026
Summary
Multiple medical policies are changing effective February 1, 2026, with significant coverage expansions for cardiovascular biomarker testing (CPT 85384, 85385) and bronchial valves, plus numerous additions of covered ICD-10 codes across various services. Several prior authorization requirements are shifting to online authorization tools while some digital health therapies are moving from not medically necessary to contract exclusions.
Action Required
By February 1, 2026: Billing team must update system settings to reflect coverage changes for CPT codes 85384 and 85385 (now covered for Medicare Advantage and Commercial), add CPT 97530 as no-cost-share for commercial mastectomy patients, and change A9291 from not medically necessary to contract exclusion for commercial plans. Update prior authorization workflows to use online authorization tool for codes 0287U, 61715, C9734, and 0552U-0555U. Verify expanded ICD-10 code coverage for codes 82610, G0465, 86003, and 86008. Claims may be denied if new coverage criteria and authorization requirements are not followed.