Medicare AdvantageBilling CodesHigh impact
Payment policy updates
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple policy updates affecting various services including COVID-19 treatments, bundled services, preventive care, and Medicare Advantage acupuncture coverage. Key changes include CPT code corrections for monoclonal antibodies, new bundling restrictions effective October 2025, and elimination of most acupuncture coverage for Medicare Advantage in 2026.
Action Required
Immediately: Update billing systems to remove outdated COVID-19 monoclonal antibody CPT codes and stop billing E&M services for pharmacist-prescribed monoclonal antibodies. By October 1, 2025: Implement new bundling edits following CMS Correct Coding Initiative guidelines - ensure billing software prevents separate billing of bundled code pairs. By January 1, 2025: Remove CPT 89258 from professional billing lists. By January 1, 2026: Update Medicare Advantage billing to cover acupuncture only for chronic lower back pain. Add CPT 92552 and 87389 to preventive benefits processing for commercial plans. Update lactation consultation billing to allow unlimited units for CPT 98960.