Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·RI · Physical Therapy, Occupational Therapy, Cardiology +4 more·Physician / Facility
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield Rhode Island is implementing major policy changes effective January 1, 2026, including new prior authorization requirements for physical therapy after 14 visits, removing prior authorization from numerous cardiology/radiology procedures, and updating coverage for various genetic testing and specialty procedures. Multiple CPT codes are changing authorization status and coverage requirements across Medicare Advantage and commercial plans.
Action Required
By January 1, 2026: Billing team must update authorization requirements for all affected codes - implement prior authorization for physical/occupational therapy visits after 14th visit per episode, remove prior authorization from extensive list of cardiology/radiology codes (78013-93319 series), update genetic testing authorization requirements, and modify coverage status for numerous specialty procedures. Update billing software rules and train staff on new requirements. Claims will be denied if proper authorization protocols are not followed.