Medicare AdvantagePrior AuthMedium impact
Microwave Tumor Ablation
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Radiology, General Surgery·Physician / Facility
Effective date
Feb 1, 2020
We identified it
Jun 19, 2026
Summary
Effective February 1, 2020, BlueCHiP for Medicare now requires prior authorization for Microwave Tumor Ablation procedures, while commercial products have this as a recommendation. This creates a billing workflow change where Medicare patients must have prior auth obtained before the procedure.
Action Required
Immediately: Billing team must update system to require prior authorization for all Microwave Tumor Ablation procedures for BlueCHiP Medicare patients. Front desk staff should verify prior auth status before scheduling these procedures. Providers should be notified that prior auth is recommended for commercial BlueCHiP products. Claims without prior authorization for Medicare patients may be denied.