Medicare AdvantagePrior AuthHigh impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island·Orthopedics, Ophthalmology, Cardiology +2 more·Physician
Effective date
Mar 1, 2025
We identified it
Jun 19, 2026
Summary
Major policy changes effective March 1, 2025 affecting multiple specialties including new prior authorization requirements for several procedures, coverage changes for genetic testing and cancer diagnostics, and revised medical necessity criteria for joint replacement surgeries.
Action Required
By March 1, 2025: Billing teams must update systems to require prior authorization for new procedure codes (27427, 29806, 29914-29916, 93656) and remove prior auth requirements for codes E0651, E0668, E0669, E0183, 65730, 67800, 67840, 67966. Update coverage status for genetic testing codes 0005U, 81313, 0360U from prior auth to covered. Revise medical necessity criteria workflows for joint replacement procedures and molecular testing. Train staff on new DME prior authorization requirements for E2298 and updated transplant testing protocols. Claims submitted without proper authorization after March 1 will be denied.