Medicare AdvantageCoverageHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Pediatrics +3 more·Physician / Facility
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
Multiple policy updates effective between July 2023 and January 2024, including removal of prior authorization requirements for home health services, coverage of new RSV and COVID vaccine codes, expanded infertility services requiring prior authorization, and expanded gender affirming care coverage.
Action Required
By January 1, 2024: Billing team must update systems to remove prior authorization requirements for home health HCPCS codes S9122-S9470 and G0151-G0300. Update coverage verification to include RSV vaccine codes 90380, 90381, 90678, 90679 and administration codes 96380, 96381 for commercial plans. Add prior authorization requirements for infertility codes 89258, 89259, 89335, 89337, 89342, 89343, 89344, 89346, 89354, 89356, S4027, S4040 for Medicare Advantage plans. Remove codes 0002M and 0003M from non-reimbursable list.