Medicare AdvantagePrior AuthMedium impact
Additional CPT code changes
Blue Cross Blue Shield of Rhode Island·RI · Diagnostic Imaging·Physician / Facility
Effective date
Apr 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island has updated their claims processing system with new CPT codes effective April 1, 2023. Twenty-three new Category III codes (0364U-0386U) are subject to medical review for Medicare Advantage plans and are not medically necessary for commercial products.
Action Required
Immediately: Update billing system to require preauthorization for codes 0364U-0386U when billing Medicare Advantage plans. Configure system to reject these codes for commercial products as not medically necessary. Train billing staff to notify members these services are non-covered before rendering. Claims without proper authorization or submitted to wrong plan types will be denied.