Medicare AdvantageCoverageHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI · ENT (Ear, Nose & Throat), Urology, Ophthalmology·Provider Update
Effective date
Jan 1, 2021
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated CPT code coverage rules effective January 1, 2021, affecting dozens of codes with new restrictions including non-coverage, medical necessity requirements, and prior authorization mandates. The billing team must update their systems to handle different coverage rules for BlueCHiP Medicare versus commercial products.
Action Required
Immediately: Billing team must update billing system rules to reflect different coverage for BlueCHiP Medicare vs commercial products. Configure prior authorization requirements for 28 codes subject to medical review. Block billing for non-covered codes (30468, 55880, 81529, 92229, 92517, 92518, 92519) and codes not separately reimbursed (57465, 76145, 99439). Update encounter forms to alert providers about medical necessity requirements. Notify patients about non-covered services before rendering care to avoid compliance issues.