Medicare AdvantageCoverageHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Pain Management, Oncology +3 more·Physician / Facility
Effective date
Feb 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI has implemented multiple policy changes across various medical services with different effective dates ranging from December 2023 to February 2024. Key changes include new CPT codes being marked as non-reimbursable, removal of prior authorization for certain cancer tests, and updates to coverage criteria for pain management procedures.
Action Required
By February 1, 2024: Billing team must update system to mark CPT codes 0775T and 0809T as non-reimbursable for commercial plans. Remove prior authorization requirement for CPT 0364U when filed with appropriate ICD-10 codes. Update fee schedules to remove codes Q4285, Q4286, 0006M and add 55970, 55980 as non-reimbursable. For pain management procedures using CPT 64628 and 64629, ensure proper plan type verification as these are covered for Medicare Advantage but not commercial plans. Update encounter forms and billing software rules accordingly.