Medicare AdvantageCoverageHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Radiology, ENT (Ear, Nose & Throat) +4 more·Physician / Facility
Effective date
Aug 1, 2023
We identified it
Jun 19, 2026
Summary
Multiple policy updates effective August 1, 2023, including consolidation of Intensity-Modulated Radiotherapy policies, new genomic testing policies with specific CPT codes, coverage changes for digestive enzyme cartridges requiring prior authorization for commercial plans, and updated cochlear implant criteria for Medicare Advantage plans.
Action Required
By August 1, 2023: Billing team must update system to require prior authorization for digestive enzyme cartridges (commercial plans only). Update coding to use new genomic testing policies for CPT codes 81445, 81449, 81450, 81451, 81455, 81456, and 0048U. Review consolidated IMRT policy for all anatomic sites. Update cochlear implant criteria for Medicare Advantage plans. Verify non-reimbursable codes A2019, A2020, A2021, A4341, A4342, E0677, E0711, J2403, K1024, K1025, K1031, K1032, K1033, L8678 are not being billed.