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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Coverage · Physician / Facility · RI · ENT (Ear, Nose & Throat), Gastroenterology, Oncology +4 moreHigh impact

Policy updates

Act
by Aug 1, 2023
Effective date
Aug 1, 2023
Identified
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.

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What to do

by Aug 1, 2023 · 5 steps
01Billing team must update system to require prior authorization for digestive enzyme cartridges (commercial plans only).
02Update coding to use new genomic testing policies for CPT codes 81445, 81449, 81450, 81451, 81455, 81456, and 0048U.
03Review consolidated IMRT policy for all anatomic sites.
04Update cochlear implant criteria for Medicare Advantage plans.
05Verify non-reimbursable codes A2019, A2020, A2021, A4341, A4342, E0677, E0711, J2403, K1024, K1025, K1031, K1032, K1033, L8678 are not being billed.

Codes mentioned

814508145181445814498145581456A2019A2020A2021A4341A4342E0677E0711J2403K1024K1025K1031K1032K1033L867896127

Original notice

Policy updates
bcbsri.com · Always check the source before changing claims.
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Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
Policy updatesHighEffective Sep 1, 2023 · Physician / FacilityHCPCS Level II Code Changes and Modifier Changes April 2023MediumEffective Apr 1, 2023 · Physician / FacilityMedical policy updatesHighEffective Aug 1, 2025 · Physician / FacilityCPT code changesHighEffective Apr 1, 2022 · 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 changesENT (Ear, Nose & Throat)GastroenterologyOncologyRadiologyUrologyOrthopedicsNeurosurgeryCode 81450Code 81451Code 81445Code 81449Code 81455Code 81456Code A2019Code A2020Code A2021Code A4341Code A4342Code E0677Code E0711Code J2403Code K1024Code K1025Code K1031Code K1032Code K1033Code L8678Code 96127

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