CommercialReimbursementMedium impact
Policy Update- Unlisted Procedures
Blue Cross Blue Shield of Rhode Island·RI · General Surgery, Orthopedics, Urology +2 more·Physician / Facility
Effective date
Apr 7, 2024
We identified it
Jun 19, 2026
Summary
Effective April 7, 2024, when a surgical procedure is performed laparoscopically but only an 'open' CPT code exists, BCBS RI will approve payment with a 20% reduction from the standard allowed amount. This affects billing for minimally invasive procedures that must use unlisted procedure codes.
Action Required
By April 7, 2024: Billing team must update fee schedules and payment expectations to reflect 20% reduced reimbursement for laparoscopic procedures billed with open procedure CPT codes. Update billing software to flag these scenarios and adjust expected payment amounts. Educate providers on documentation requirements to clearly indicate laparoscopic approach when using open procedure codes.