Medicare AdvantageCoverageHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Radiology, Pain Management, Oncology +5 more·Physician / Facility
Effective date
Sep 1, 2023
We identified it
Jun 19, 2026
Summary
Multiple policy changes effective September 1, 2023, including reduced radiology payment rates (60.4% to 60%), new prior authorization requirements for several services, coverage changes for COVID-19 testing and treatments, and updates to telemedicine coverage. Several temporary COVID-19 policies are also being discontinued.
Action Required
By September 1, 2023: Billing team must update system to reflect 60% payment rate for subsequent radiology services (down from 60.4%). Update prior authorization requirements for thoracic epidural injections (commercial only), hydrogel spacer for prostate cancer radiotherapy, and specified DME codes. Remove Prevention Medicine E&M codes (99381-99397) from telemedicine billing. Update unit limitations for specified A-codes and K1005. Verify all COVID-19 related billing follows new guidelines with cost-share changes. Front desk staff must ensure provider orders are obtained for all COVID-19 tests.