Traditional MedicarePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Sleep Medicine, Vascular Surgery, Oncology +2 more·Physician / Facility
Effective date
Sep 1, 2024
We identified it
Jun 19, 2026
Summary
Multiple prior authorization requirements are being removed effective September 1, 2024, including sleep studies for Medicare, genetic testing for specific blood disorders, and cancer genomic testing for lung and colorectal cancers. Additionally, new prior authorization requirements are added for lymphedema treatments effective August 1, 2024.
Action Required
By September 1, 2024: Billing team must update system to remove prior authorization requirements for CPT 95805 (Medicare only), CPT 81219/81279/81338/81339 when billed with diagnosis D45/D47.3/D75.1, CPT 0027U with same diagnoses, CPT 0048U for lung/colorectal cancer, and CPT 81445/81449/81457/81458/81462/81463 for specific cancer diagnoses. By August 1, 2024: Add prior authorization requirement for lipedema treatments on Medicare Advantage plans. Update encounter forms and train staff on new requirements.