Medicare AdvantagePrior AuthMedium impact
Outpatient Pulmonary Rehabilitation
Blue Cross Blue Shield of Rhode Island·RI · Pulmonology, Cardiology, PM&R (Physical Medicine & Rehab)·Physician / Facility
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Effective January 1, 2020, BlueCross BlueShield of Rhode Island removed the prior authorization requirement for Outpatient Pulmonary Rehabilitation services for both BlueCHiP Medicare and commercial products. The service remains covered but no longer requires pre-approval.
Action Required
Billing team should update system settings to remove prior authorization requirements for outpatient pulmonary rehabilitation services for BCBS RI BlueCHiP Medicare and commercial plans. Update encounter forms and staff workflows to reflect that these services can be scheduled and billed directly without prior approval.