Prior Authorization of Cardiology and Radiology Services
Defines when prior authorization is required for cardiology and radiology tests and which providers/plans are affected for Blue Cross & Blue Shield of Rhode Island (BCBSRI). Applies to Medicare Advantage and Commercial products and specifies exemptions for certain BCBSRI-contracted primary care providers and clinical settings.
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 stated exemptions and effective dates.
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