Medicare AdvantageBilling CodesHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·Physical Therapy, Occupational Therapy, Allergy & Immunology +2 more·Physician / Facility
Effective date
Apr 1, 2024
We identified it
Jun 19, 2026
Summary
Multiple policy updates affecting various specialties with different effective dates. Key changes include new modifier requirements for speech therapy claims, coverage determinations for gene therapies and allergy testing procedures, and revised unit limits for allergy testing codes.
Action Required
Before April 1, 2024: Billing team must update systems to append modifier GN to all speech therapy CPT codes for both Medicare Advantage and commercial plans. Update allergy testing code limits: CPT 95004 to 80 units max, 95027 to 90 units max, 95052 to 36 units max. Mark J1413 as non-covered for Duchenne muscular dystrophy gene therapy. Stop billing CPT codes 86003 and 86008 for ELISA/Act testing and add CPT 86849 for unlisted allergy tests. Update cardiovascular biomarker coverage for Medicare Advantage plans only.