Summary
Blue Cross Blue Shield of Rhode Island updated CPT code coverage rules effective July 1, 2022, with multiple codes now requiring medical review for Medicare Advantage plans and being deemed not medically necessary for commercial products. The billing team must update their systems to handle different coverage rules for the same codes depending on plan type.
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What to do
immediately · 4 steps
01Billing team must update claims processing system to handle plan-specific coverage rules for the listed codes.
02Configure system to require medical review/preauthorization for Medicare Advantage plans while flagging codes as not medically necessary for commercial products.
03Update encounter forms to alert providers about coverage differences between plan types.
04Notify patients about non-covered services prior to rendering them as required for participating providers.
Codes mentioned
C9094C9095C9096C9097C9098J1306J1551J2356J2779J9331J9332G0308G0309A9596A960190584Q4259Q4260Q4261
Original notice
CPT code changes
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Policy updatesHighEffective Jun 1, 2023 · Provider UpdateCPT® and HCPCS Level II code changesMediumEffective Jul 1, 2018 · Physician / FacilityCPT® and HCPCS Level II code changesHighEffective Jan 1, 2019 · Physician / FacilityAdditional CPT and HCPCS Level II code changesMediumEffective Jul 1, 2019 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list