Medicare AdvantageCoverageHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jul 1, 2022
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated CPT code coverage rules effective July 1, 2022, with multiple codes now requiring medical review for Medicare Advantage plans and being deemed not medically necessary for commercial products. The billing team must update their systems to handle different coverage rules for the same codes depending on plan type.
Action Required
Immediately: Billing team must update claims processing system to handle plan-specific coverage rules for the listed codes. Configure system to require medical review/preauthorization for Medicare Advantage plans while flagging codes as not medically necessary for commercial products. Update encounter forms to alert providers about coverage differences between plan types. Notify patients about non-covered services prior to rendering them as required for participating providers.