Medicare AdvantageBilling CodesHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI · ENT (Ear, Nose & Throat), Orthopedics, Gastroenterology +4 more·Physician / Facility
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated CPT code coverage rules effective January 1, 2023, with specific changes affecting reimbursement, medical necessity requirements, and prior authorization for dozens of codes across multiple specialties. One code (0359U) has a delayed effective date of March 1, 2023.
Action Required
Immediately: Billing team must update claims processing system with new CPT code coverage rules - mark specified codes as not covered, not medically necessary, or not separately reimbursed based on plan type. Update prior authorization requirements for medical review codes including 43291, 69728, 81418, 81441, 81449, 81451, 81456, 0742T. By March 1, 2023: Add prior authorization requirement for code 0359U. Notify patients of non-covered services before rendering care to avoid billing issues.