Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · OB-GYN, Ophthalmology, Urology +5 more·Physician / Facility
Effective date
Feb 1, 2026
We identified it
Jun 19, 2026
Summary
Multiple medical policies are being updated with changes to prior authorization requirements, covered diagnosis codes, and billing procedures across various specialties. Key changes include removal of prior authorization for several CPT codes, addition of new ICD-10 codes for breast cancer-related services, and updates to genetic testing coverage criteria.
Action Required
By February 1, 2026: Billing team must update system to remove prior authorization requirements for CPT 57288, and update genetic testing codes 0018U, 0026U, 0245U, and 81546 to covered status. By March 1, 2026: Remove prior auth for CPT 67911 (commercial only), all breast reconstruction codes when filed with C50.A0-C50.A2, add new ICD-10 codes C50.A0-C50.A2 for breast cancer-related services, update ophthalmic codes 92133, 92134, 92137 with new covered diagnoses H40.841-H40.843, and implement InterQual criteria for multiple genetic testing codes. Update billing software, encounter forms, and train staff on new coverage criteria.