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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Coverage · Provider Update · RI · ENT (Ear, Nose & Throat), Urology, OphthalmologyHigh impact

CPT code changes

Act
immediately
Effective date
Jan 1, 2021
Identified
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.

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What to do

immediately · 5 steps
01Billing team must update billing system rules to reflect different coverage for BlueCHiP Medicare vs commercial products.
02Configure prior authorization requirements for 28 codes subject to medical review.
03Block billing for non-covered codes (30468, 55880, 81529, 92229, 92517, 92518, 92519) and codes not separately reimbursed (57465, 76145, 99439).
04Update encounter forms to alert providers about medical necessity requirements.
05Notify patients about non-covered services before rendering care to avoid compliance issues.

Codes mentioned

304685588081529922299251792518925195746576145994396970569706712718116881191811928119381194812788127981338813398134781348813518135281353813578136081419815468155499417

Original notice

CPT code changes
bcbsri.com · Always check the source before changing claims.
View original ↗

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Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesENT (Ear, Nose & Throat)UrologyOphthalmologyCode 30468Code 55880Code 81529Code 92229Code 92517Code 92518Code 92519Code 57465Code 76145Code 99439Code 69705Code 69706Code 71271Code 81168Code 81191Code 81192Code 81193Code 81194Code 81278Code 81279Code 81338Code 81339Code 81347Code 81348Code 81351Code 81352Code 81353Code 81357Code 81360Code 81419Code 81546Code 81554Code 99417

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