All PlansCoverageHigh impact
Policy Updates
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Oncology, Cardiology +2 more·Physician / Facility
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
BCBSRI has updated multiple medical policies with new criteria, coding changes, and coverage modifications effective at various dates from August 2022 through January 2023. Key changes include new requirements for joint replacement surgery, radiation therapy updates, DME prior authorization changes, and COVID-19 policy clarifications.
Action Required
By January 1, 2023: Billing team must update prior authorization requirements for standing frames (DME) for commercial products only. Review and implement new criteria for Total Joint Arthroplasty requiring diabetes control, BMI, and smoking status documentation effective December 1, 2022. Update billing system to reflect CPT codes 33267 and 33269 now covered under Surgical Left Atrial Appendage Occlusion policy. Verify ICD-10 code C84.7 is linked to CPT 86300 for tumor marker billing. Update telemedicine billing to include POS 10 and modifier FQ effective April 1, 2022.