Medicare AdvantagePrior AuthMedium impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Cardiology, Hematology, Orthopedics +1 more·Physician / Facility
Effective date
Nov 1, 2025
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island has updated multiple policies with various effective dates from October 1 to December 1, 2025. Key changes include removing prior authorization for genomic testing codes 81450 and 81451, covering cardiac monitoring codes for Medicare Advantage, and shifting several DME codes to use online authorization tools instead of traditional medical policies.
Action Required
By November 1, 2025: Billing team must update system to remove prior authorization requirements for CPT codes 81450 and 81451 for genomic testing. Add coverage for CPT codes 33289, 93264, and G0555 for cardiac monitoring on Medicare Advantage plans. Update DME authorization workflows for codes L5615, K0898, K0812, E0983, and E0984 to use online authorization tool instead of traditional medical policy criteria. By December 1, 2025: Update L2006 to use online authorization tool for commercial products and ensure modifier QL is only applied to ambulance codes A0428 and A0429.