Cardiology and Radiology Services Prior Authorization
This policy governs prior authorization requirements for cardiology and radiology services for Blue Cross & Blue Shield of Rhode Island (BCBSRI) Medicare Advantage and Commercial products, specifying when authorization is required, exemptions, and vendor contact. It affects ordering physicians and BCBSRI-contracted providers.
Effective 10/1/2025, for Fully-Funded Commercial Products only, prior authorization requests may not be needed when the requesting physician is a BCBSRI Contracted Primary Care Provider.
Effective 5/15/2025, prior authorization requests for certain services may not be needed when the requesting physician is a BCBSRI contracted Primary Care Provider; see addendum in attached code grid.
Prior authorization is required for Medicare Advantage Plans and recommended for Commercial Products (with specified exemptions).
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