Medicare AdvantageCoverageMedium impact
Additional CPT and HCPCS Level II code changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
BCBS Rhode Island updated coverage and payment rules for new CPT and HCPCS codes effective October 1, 2019. Multiple codes now require medical review, while others are not covered or not medically necessary for different plan types.
Action Required
By October 1, 2019: Billing team must update system to require prior authorization for BlueCHiP Medicare patients using codes subject to medical review. Update billing software to flag non-covered codes (0113U, J7401, J0593, J3031, J7331, J7332) to prevent claim denials. Notify patients of non-covered services before rendering care as required for participating providers.