Medicare AdvantagePrior AuthHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oral & Maxillofacial Surgery, Urology·Physician / Facility
Effective date
May 1, 2023
We identified it
Jun 19, 2026
Summary
Multiple policy updates effective May 1, 2023, including new Medicare Advantage coverage for orthognathic surgery, revised prior authorization requirements for prostate procedures, new HCPCS codes requiring prior auth, updated nutrient panel billing requirements, and credentialing process changes.
Action Required
By May 1, 2023: Billing team must update system to require prior authorization for HCPCS codes C7504, C7505, C7507, and C7508 for all plan types. Enable Medicare Advantage billing for orthognathic surgery when criteria are met. Update nutrient panel billing to use only unlisted codes 81479 or 84999 instead of individual component codes. Configure CPT 0421T (Aquablation) as covered for commercial plans only when criteria met. Route water vapor therapy (53854) requests through web-based prior auth tool for commercial plans.