All PlansReimbursementMedium impact
Policy Update- Unlisted Procedures
Blue Cross Blue Shield of Rhode Island·RI · General Surgery, Orthopedics, OB-GYN +4 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' procedure CPT code exists, the reimbursement will be reduced by 20% from the standard allowed amount. This affects billing for minimally invasive procedures where no specific laparoscopic CPT code is available.
Action Required
By April 7, 2024: Billing team must update fee schedules and billing system to apply 20% reduction to reimbursement calculations when billing open procedure CPT codes for laparoscopically performed surgeries. Update procedure documentation requirements to clearly indicate surgical approach (open vs laparoscopic) on claims. Notify surgeons to specify surgical approach in operative reports.