Medicare AdvantagePrior AuthMedium impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Urology, Oncology, Cardiology +3 more·Physician / Facility
Effective date
Oct 1, 2024
We identified it
Jun 19, 2026
Summary
Multiple policy updates effective October 1, 2024, including prior authorization changes for prostate procedures (CPT 53854), updated coverage criteria for breast radiation therapy, new covered compression garment codes for mastectomy patients, and coverage changes for glaucoma testing (CPT 0198T).
Action Required
By October 1, 2024: Update prior authorization system for CPT 53854 (Water Vapor Thermal Therapy) to use InterQual criteria for Medicare members. Update billing system to add new compression garment HCPCS codes (A6520-A6593) with zero cost-share for commercial mastectomy patients. Stop billing CPT 0198T for glaucoma testing - mark as not covered for Medicare Advantage and not medically necessary for commercial plans. Review IMRT breast treatment criteria for updated medical necessity requirements.