Medicare AdvantagePrior AuthHigh impact
Policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Urology, Orthopedic Surgery +8 more·Physician / Facility
Effective date
Apr 1, 2023
We identified it
Jun 19, 2026
Summary
Multiple policy changes effective April 1, 2023, including new prior authorization requirements for genetic testing and cancer profiling codes, coverage changes for prostate treatments, and updates to various medical procedures. Most changes affect Medicare Advantage plans with some commercial plan updates.
Action Required
By April 1, 2023: Billing team must update prior authorization requirements for genetic testing codes 81529, 0022U, 0037U, 0048U, 0111U, 0172U, and 0239U in billing system. Update coverage status for High-Intensity Focused Ultrasound (not covered for Medicare Advantage). Remove prior authorization for HCPCS L5982. Update spinal procedure prior auth to include CPT 0775T and 22860. Add new 2023 CPT codes 99418, G0316-G0318 for prolonged services. Update pediatric dental codes effective January 1, 2023.