Medicare AdvantagePrior AuthHigh impact
PA Requirement changes for Medicare Members
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Vascular Surgery, Cardiology·Physician / Facility
Effective date
Apr 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI is removing prior authorization requirements for Synvisc (J7325) and carotid angioplasty/stent procedures, while adding prior auth requirements for Duralane (J7318) and Orthovisc (J7324) for Medicare members effective April 1, 2024.
Action Required
By March 31, 2024: Billing team must update prior authorization requirements in billing system - remove PA requirements for Synvisc (J7325) and carotid angioplasty codes 37215, 37216, 37217, and add PA requirements for Duralane (J7318) and Orthovisc (J7324). Update encounter forms and notify providers that PA is now required for Duralane and Orthovisc injections. Claims will be denied without proper PA status.