Medicare AdvantageCoverageMedium impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Apr 1, 2021
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island has implemented April 2021 CPT code changes with new coverage designations including codes marked as not covered, not medically necessary, requiring medical review, or pending CMS determination. Specific HCPCS codes 0242U-0247U now have varying medical review requirements based on plan type.
Action Required
Immediately: Billing team must update system to require medical review for codes 0242U and 0245U for all Medicare Advantage and commercial plans. Mark codes 0243U, 0244U, 0246U, and 0247U as requiring medical review for Medicare Advantage plans only and not medically necessary for commercial products. Update encounter forms to alert providers of new coverage designations and medical review requirements to prevent claim denials.