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.
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What to do
by Oct 1, 2023 · 4 steps
01Billing team must update systems to require prior authorization for CPT 37216 (carotid angioplasty) for both Medicare Advantage and commercial plans.
02Update coding for platelet-rich plasma procedures - CPT 0481T and HCPCS P9020 will be not covered for Medicare Advantage and not medically necessary for commercial.
03For hospital-based practices: immediately switch facility outpatient mental health services from CMS-1500 to UB-04 billing forms.
04Update prior authorization vendor for CPT 0809T spine procedures effective August 1, 2023.
Codes mentioned
37216P90203724237243C9150Q4265Q4266Q4267Q4268Q4269Q4270Q4271Q4272Q4273Q4274Q4275Q4276Q4277Q4278Q4279Q4280Q4281Q4282Q4283Q4284Q4285
Original notice
Policy Updates
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →CPT code changesHighEffective Jul 1, 2023 · Physician / FacilityHCPCS Level II Code Changes and Modifier Changes April 2023MediumEffective Apr 1, 2023 · Physician / FacilityMedical policy updatesHighEffective Sep 1, 2024 · Physician / FacilityMedical policy updatesHighEffective Jun 1, 2026 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list
Related policy hubs
Blue Cross Blue Shield of Rhode Island policiesRI policy changesCardiologyVascular SurgeryOrthopedicsUrologyPsychiatryNeurosurgeryCode 37216Code P9020Code 37242Code 37243Code C9150Code Q4265Code Q4266Code Q4267Code Q4268Code Q4269Code Q4270Code Q4271Code Q4272Code Q4273Code Q4274Code Q4275Code Q4276Code Q4277Code Q4278Code Q4279Code Q4280Code Q4281Code Q4282Code Q4283Code Q4284Code Q4285