Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Hematology, Oncology, Vascular Surgery +1 more·Physician / Facility
Effective date
Jun 1, 2026
We identified it
Jun 19, 2026
Summary
Multiple medical policy updates effective June through August 2026 affecting prior authorization requirements, coverage determinations, and billing procedures across various specialties. Key changes include removal of prior authorization for several CPT codes, coverage status changes for autism services and biomarker testing, and new medical criteria for vascular procedures.
Action Required
By June 1, 2026: Billing team must update authorization requirements for blood product typing codes 0001U and 0084U to reference new medical policy instead of online tool. By July 1, 2026: Remove prior authorization for CPT codes 0408T-0411T, 0415T-0418T, and 0412T-0414T for Medicare Advantage plans only, and add prior authorization requirement for L5827. By August 1, 2026: Update billing system to reflect coverage changes for autism services (not covered for Medicare Advantage), biomarker testing codes with new coverage/prior auth status, prosthetic codes A8005/A8006 (not covered), and revised medical criteria for vascular embolization codes 37242/37243. Claims will be processed according to new coverage determinations.