Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Oral & Maxillofacial Surgery, Plastic Surgery, Urology +5 more·Physician / Facility
Effective date
Jul 1, 2026
We identified it
Jun 19, 2026
Summary
Effective July 1, 2026, multiple policy changes include removing prior authorization for chronic liver disease testing (CPT 0344U), adding prior authorization requirements for tibial nerve stimulation, changing orthognathic surgery codes to use general prior authorization criteria instead of specialty-specific criteria, and updating various other testing and procedure requirements across Medicare Advantage and commercial plans.
Action Required
By July 1, 2026: Update billing system to remove prior authorization requirement for CPT 0344U (chronic liver disease testing) but note it will be non-covered/not medically necessary. Add prior authorization requirement for CPT 0587T (tibial nerve stimulation) for commercial plans. Remove prior authorization for Medicare CPT codes 0588T, 0589T, 0590T. Update all orthognathic surgery codes (21141-21209) to use general prior authorization criteria. Add diagnosis code edits for allergy testing, bacterial vaginosis testing, and biomarker codes. Update DME prior authorization processes for prosthetic codes L5827, L5841, L5926 to use InterQual criteria instead of BCBSRI medical policies.