When does this change take effect?

This change is effective Apr 1, 2025.

CommercialCoverageMedium impact

Payment policy updates

Q: Who is affected by this change?

This affects Blue Cross Blue Shield of Rhode Island Allergy & Immunology, Family Medicine, Internal Medicine, Pediatrics, ENT (Ear, Nose & Throat) providers in RI on Commercial plans.

Blue Cross Blue Shield of Rhode Island·RI · Allergy & Immunology, Family Medicine, Internal Medicine +2 more·Physician

Effective date

Apr 1, 2025

We identified it

Jun 19, 2026

Days to comply

—

Summary

BCBSRI has updated their payment policy to clarify that oral and sublingual delivery of immunotherapy is not covered, while injection-based allergy immunotherapy remains covered. This affects billing for sublingual immunotherapy tablets and oral drops used in allergy treatment.

Action Required

Action needed

Before April 1, 2025: Billing team must stop submitting claims for oral/sublingual immunotherapy delivery to BCBSRI. Update billing system to flag these services as non-covered for BCBSRI patients. Continue billing injection-based allergy immunotherapy as usual. Notify providers to inform patients that oral/sublingual immunotherapy will not be covered by BCBSRI.

Related policy hubs

Blue Cross Blue Shield of Rhode Island policies RI policy changes Allergy & Immunology Family Medicine Internal Medicine Pediatrics ENT (Ear, Nose & Throat)