Medicare AdvantagePrior AuthMedium impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Pain Management, Orthopedic +2 more·Provider Update
Effective date
Jun 1, 2025
We identified it
Jun 19, 2026
Summary
Multiple policy changes take effect June 1 and August 1, 2025, including new prior authorization requirements for hyperthermia treatments, nine laboratory testing codes becoming non-covered, and changes to device removal coverage criteria. Most changes affect both Medicare Advantage and commercial plans.
Action Required
By June 1, 2025: Update encounter forms to note cost share waiver clarifications for behavioral health integration services. By August 1, 2025: Billing team must update system to require prior authorization for hyperthermia CPT codes 77600, 77610, 77615, 77605, 77620. Mark laboratory codes 0371U, 0372U, 0373U, 0374U, 0376U, 0377U, 0384U, 0385U, 0390U as non-covered for Medicare Advantage and not medically necessary for commercial. Update medical criteria requirements for device removal codes 0269T, 0270T, 0271T, 0511T, 64595, 0588T, 0818T. Claims without proper authorization or documentation will be denied.