Medicare AdvantagePrior AuthMedium impact
Surgical and Debulking Treatments for Lymphedema
Blue Cross Blue Shield of Rhode Island·RI · Plastic Surgery, Vascular Surgery, General Surgery·Physician / Facility
Effective date
Oct 1, 2021
We identified it
Jun 19, 2026
Summary
Effective October 1, 2021, BCBSRI now requires preauthorization for lymph node transplant, lymphovenous bypass, and debulking of a limb procedures for Medicare Advantage and commercial plan members. This applies specifically to surgical and debulking treatments for lymphedema.
Action Required
Immediately: Billing team must update system to require prior authorization for lymph node transplant, lymphovenous bypass, and debulking of limb procedures for Medicare Advantage and commercial BCBSRI members. Update encounter forms and provider workflows to obtain preauth before scheduling these lymphedema treatments. Claims will be denied without prior authorization.