Medicare AdvantagePrior AuthMedium impact
Additional CPT and HCPCS Level II code changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jul 1, 2020
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated coverage rules for 52 new CPT and HCPCS codes effective July 1, 2020. These Category III CPT codes (0594T-0619T) and PLA codes (0172U-0201U) require medical review for Medicare plans and are considered not medically necessary for commercial plans.
Action Required
Billing team must update system to flag these Category III CPT codes (0594T-0619T) and PLA codes (0172U-0201U) for prior authorization when billing BlueCHiP Medicare plans. For commercial BCBS Rhode Island plans, notify patients these services are not medically necessary and may not be covered before rendering services.