Medicare AdvantagePrior AuthHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Endocrinology, Infectious Disease +6 more·Physician / Facility
Effective date
Jun 1, 2024
We identified it
Jun 19, 2026
Summary
Multiple policy changes effective June 1, 2024, including new prior authorization requirements for genomic testing and continuous glucose monitoring codes, coverage changes for pulmonary nodule testing, and expanded non-covered diagnosis codes for migraine surgery.
Action Required
By June 1, 2024: Billing team must update system to require prior authorization for CPT codes 81457-81459, 81462-81464 (genomic testing), 0446T (continuous glucose monitoring), and 0080U (pulmonary nodule testing). Update encounter forms and denial edits to block CPT codes 30140, 30520, 64716, 67900 when paired with expanded migraine diagnosis codes G43.E01-G43.E19. Remove CMS MUE limits for autism codes 0362T, 0373T, 97151-97158 in billing system.