CommercialCoverageMedium impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Cardiology +1 more·Physician / Facility
Effective date
Jul 1, 2023
We identified it
Jun 19, 2026
Summary
Three policy updates effective July 1, 2023: HCPCS A4634 (therapeutic light bulb replacements) changes from not medically necessary to not reimbursable for all plans. EKG billing during preventive visits has updated diagnosis restrictions for separate reimbursement. Autologous chondrocyte implantation policy will be archived but prior authorization requirements continue.
Action Required
By July 1, 2023: Billing team must stop submitting claims for HCPCS A4634 (therapeutic light bulb replacements) as these are now not reimbursable for all plan types. Update billing system to flag CPT 93000 when billed with preventive E/M visits to ensure proper diagnosis coding for separate reimbursement. Continue obtaining prior authorization for autologous chondrocyte implantation procedures using online prior authorization tools.