Medicare AdvantagePrior AuthMedium impact
Utilization Updates for IQ Medicare Module InterQual®
Blue Cross Blue Shield of Rhode Island·RI · Ophthalmology, Plastic Surgery·Physician / Facility
Effective date
Feb 1, 2022
We identified it
Jun 19, 2026
Summary
BCBSRI updated their InterQual Medicare module for blepharoplasty and ptosis procedures, consolidating all prior authorization requirements into one comprehensive module. The update includes 22 specific CPT codes that require prior authorization and references the CMS Local Coverage Article for medical policy guidance.
Action Required
Immediately: Billing team must ensure all blepharoplasty and ptosis procedures using the 22 specified CPT codes have prior authorization obtained through BCBSRI's web-based tool before scheduling. Update billing system to flag these codes for prior auth requirement. Reference CMS Local Coverage Article A52837 for medical necessity documentation requirements. Claims submitted without proper prior authorization will be denied.