Medicare AdvantagePrior AuthHigh impact
Prior Authorization of Spinal Procedures
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Neurosurgery, Pain Management·Physician / Facility
Effective date
Nov 1, 2025
We identified it
Jun 19, 2026
Summary
Effective November 1, 2025, prior authorization requirements for spinal procedures will be expanded to include fully-funded commercial products, with several CPT codes moving between different prior authorization policies. Some codes will have prior auth added while others will have it removed or changed to covered status.
Action Required
By November 1, 2025: Billing team must update prior authorization requirements for spinal procedure codes - add prior auth for CPT codes 22585, 22840, and 27280 for Medicare Advantage plans, remove prior auth for HCPCS C9757 for Medicare Advantage and Commercial products, and update status to covered for HCPCS E0749 and C1821 for Commercial products. Update billing software and encounter forms to reflect new prior authorization requirements for fully-funded commercial products. Claims submitted without proper prior authorization will be denied.