Medicare AdvantagePrior AuthHigh impact
Policies recently updated
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, OB-GYN, Neurology +5 more·Physician / Facility
Effective date
Oct 1, 2022
We identified it
Jun 19, 2026
Summary
Multiple BCBS Rhode Island policy updates affecting various specialties, including new CPT/ICD-10 codes for cartilage treatments, expanded uterine fibroid procedures, Aduhelm prior authorization requirements, genetic testing authorization changes, and coverage updates for diabetic retinal screening and acupuncture services.
Action Required
By October 1, 2022: Update billing system to require prior authorization for HCPCS J0172 (Aduhelm) for Medicare Advantage and Commercial plans. Remove authorization requirements for genetic testing code 83080. Update authorization requirements for genetic testing codes 81175, 81176, 81238, 81247, 81248, 81287, 81334, 81335 to use InterQual criteria. Add coverage for CPT 96040 with diagnosis Z31.5 for preventive genetic counseling. Add lower back pain diagnoses M54.50, M54.51, M54.59 for acupuncture coverage in Medicare Advantage plans.