CommercialBilling CodesMedium impact
Payment Policies
Blue Cross Blue Shield of Rhode Island·RI · OB-GYN, Pediatrics, Family Medicine·Physician
Effective date
Sep 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI now requires lactation consultation services to be billed with the mother as the patient, not the infant. Claims submitted under infants (ages 0-12 months) will be denied, and only one unit of CPT 98960 per date of service will be reimbursed.
Action Required
By September 1, 2025: Billing team must update system to bill lactation consultation CPT 98960 under mother's patient account only, never under infant patients (0-12 months). Limit billing to maximum one unit per date of service. Update encounter forms and train staff on patient assignment for lactation services. Claims billed incorrectly under infant will be denied.