Medicare AdvantageBilling CodesHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jan 1, 2022
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island updated CPT code coverage and payment rules effective January 1, 2022. Multiple codes now require prior authorization, are not covered, or are not separately reimbursed, with different rules for Medicare Advantage vs Commercial plans.
Action Required
Immediately: Billing team must update system settings for affected CPT codes based on plan type. Stop billing non-covered codes (43497, 64628, 64629, 81560, 0693T, 0702T, 0703T) to Commercial plans. Set up prior authorization requirements for codes subject to medical review including 64584, 69726, 69727, 81349, 81523, and others listed. Update encounter forms to flag codes requiring preauth for BlueCHiP Medicare and authorization recommendations for Commercial. Notify patients about non-covered services before rendering care to avoid billing disputes.