Medicare AdvantagePrior AuthMedium impact
New Technology (Formerly CPT® Category III Codes)
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
May 1, 2021
We identified it
Jun 19, 2026
Summary
Effective May 1, 2021, several CPT codes previously classified as Category III (New Technology) changed from 'not covered' to 'authorization required' status for Medicare Advantage plans due to retired CMS guidance. This means procedures that were previously denied will now require prior authorization before being performed.
Action Required
Review the full policy document linked in the update to identify specific CPT codes that changed from not covered to authorization required. Update billing system to flag these codes for prior authorization requirements for Medicare Advantage patients. Train staff to obtain authorization before performing these procedures to avoid claim denials.