Back to dashboard
Medicare AdvantagePrior AuthHigh impact

Medical policy updates

Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Oncology, Radiology +3 more·Physician / Facility
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Days to comply

Summary

Multiple prior authorization requirements are being removed or added across various specialties starting October and November 2025. Key changes include removing prior auth for radiation therapy codes, adding prior auth for wrist surgery and spinal procedures, and moving medical criteria to online authorization tools.

Action Required

Action needed
By October 1, 2025: Update billing system to remove prior authorization requirements for radiation therapy codes (77301, 77338, 77385, 77386, G6015, G6016, 77520, 77522, 77523, 77525, 32701, 77373, 77435, 55875, 55876). By November 1, 2025: Add prior authorization requirements for CPT 25447 (wrist surgery), update medical criteria location for CPT 25448, remove prior auth for CPT 63663 and 63664, add modifier QL requirement for ambulance codes A0427 and A0428, and update prior authorization criteria locations for genetic testing codes to online tool. Update encounter forms and train staff on new requirements. Claims without proper authorization will be denied.

Affected Billing Codes

55875
55876
77301
77338
77385
77386
G6015
G6016
77520
77522
77523
77525
32701
77373
77435
25447
25448
63663
63664
A0427
A0428
C83.1A
Z85.72
81529
81479
82233
82234
84393
84394
98978
A9291
17106
17107
17108
L5615
22857
22860
22862
22586
20975
E0749
22867
22868
22869
22870
C1821
27278
27279
C9757
22585
22840
27280