CommercialReimbursementHigh impact
Payment policy updates
Blue Cross Blue Shield of Rhode Island·RI · Emergency Medicine·Physician / Facility
Effective date
Sep 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI is implementing new review policies for Emergency Department E/M coding levels (99281-99285) based on patient complexity, diagnostic services, and resource utilization. Claims may be downgraded to lower E/M levels or denied if coding doesn't match actual resource use. A new telemedicine modifier GT was also added for Critical Access Hospitals.
Action Required
Immediately: ED billing teams must ensure E/M code levels (99281-99285) accurately reflect patient complexity, diagnostic services performed, and resource utilization per CMS guidelines. Review current ED coding practices and prepare detailed documentation to support higher-level E/M codes. Expect potential downgrades or denials with appeal opportunities. For Critical Access Hospitals: update billing systems to use modifier GT for telehealth services under Optional Payment Method II.