Medicare AdvantagePrior AuthHigh impact
Policy Updates
Blue Cross Blue Shield of Rhode Island·RI · Cardiology, Vascular Surgery, Orthopedics +3 more·Physician / Facility
Effective date
Oct 1, 2023
We identified it
Jun 19, 2026
Summary
Multiple policy changes effective October 1, 2023, including new prior authorization requirements for carotid angioplasty (CPT 37216), coverage changes for platelet-rich plasma procedures, and requirement that facility-based outpatient mental health services be billed on UB-04 forms instead of CMS-1500 forms.
Action Required
By October 1, 2023: Billing team must update systems to require prior authorization for CPT 37216 (carotid angioplasty) for both Medicare Advantage and commercial plans. Update coding for platelet-rich plasma procedures - CPT 0481T and HCPCS P9020 will be not covered for Medicare Advantage and not medically necessary for commercial. For hospital-based practices: immediately switch facility outpatient mental health services from CMS-1500 to UB-04 billing forms. Update prior authorization vendor for CPT 0809T spine procedures effective August 1, 2023.