Medicare AdvantagePrior AuthHigh impact
Medical Policy updates
Blue Cross Blue Shield of Rhode Island·RI · PM&R (Physical Medicine & Rehab), Pain Management, Orthopedics +2 more·Physician / Facility
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island updated multiple medical policies effective July 1, 2024, including new prior authorization requirements for DME codes K0898 and L5999, coverage changes for bone turnover markers and laser treatments, and code transfers between policies. Most changes affect both Medicare Advantage and commercial plans with different coverage determinations.
Action Required
By July 1, 2024: Billing team must update system to require prior authorization for HCPCS codes K0898 and L5999 for DME claims. Update coverage rules for CPT codes 0766T and 0767T (now not covered for Medicare Advantage, not medically necessary for commercial). Change CPT 82523 to require covered diagnosis verification. Stop using CPT codes 66174/66175 for viscocanalostomy procedures - use CPT 66999 instead. Update encounter forms and notify providers of coverage changes to prevent claim denials.