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.
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What to do
by Sep 1, 2023 · 6 steps
01Billing team must update system to reflect 60% payment rate for subsequent radiology services (down from 60.4%).
02Update prior authorization requirements for thoracic epidural injections (commercial only), hydrogel spacer for prostate cancer radiotherapy, and specified DME codes.
03Remove Prevention Medicine E&M codes (99381-99397) from telemedicine billing.
04Update unit limitations for specified A-codes and K1005.
05Verify all COVID-19 related billing follows new guidelines with cost-share changes.
06Front desk staff must ensure provider orders are obtained for all COVID-19 tests.
Codes mentioned
96127A4281A4282A4283A4284A4285A4286K1005E0183E0983E0984E1802K0812L2006813279938199382993839938499385993869938799391993929939399394993959939699397992119921299217992189921999220992249922599226K1016K1017K1018K1019A2019A2020A2021A4341A4342E0677E0711J2403K1024K1025K1031K1032K1033L8678
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 →COVID-19 Related Policy Updates Regarding the Public Health Emergency EndingHighEffective May 12, 2023 · Provider UpdatePolicy updatesHighEffective Aug 1, 2023 · Physician / FacilityHints for HEDIS® (and more)MediumEffective Jan 1, 2022 · PhysicianHCPCS Level II Code Changes and Modifier Changes April 2023MediumEffective Apr 1, 2023 · 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 changesPain ManagementGeneral PracticePediatricsOncologyRadiologyFamily MedicineInternal MedicineCode 96127Code A4281Code A4282Code A4283Code A4284Code A4285Code A4286Code K1005Code E0183Code E0983Code E0984Code E1802Code K0812Code L2006Code 81327Code 99381Code 99382Code 99383Code 99384Code 99385Code 99386Code 99387Code 99391Code 99392Code 99393Code 99394Code 99395Code 99396Code 99397Code 99211Code 99212Code 99217Code 99218Code 99219Code 99220Code 99224Code 99225Code 99226Code K1016Code K1017Code K1018Code K1019Code A2019Code A2020Code A2021Code A4341Code A4342Code E0677Code E0711Code J2403Code K1024Code K1025Code K1031Code K1032Code K1033Code L8678