Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerPolicy UpdatesGeneral SurgeryBCBS Rhode Island Implant Removal Coverage | OpenP…
    Ask Trek AI about this page
    DraftBlue Cross Blue Shield - Rhode IslandPolicy N/A

    Removal of Implantable Devices

    Customize your policy alerts

    Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts

    Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Medical-necessity criteria and prior-authorization requirements for removal of surgically implanted devices, including removal with reinsertion, replacement, or revision, for Commercial Products and Medicare Advantage Plans.

    Policy Summary
    PayerBlue Cross Blue Shield - Rhode Island
    PolicyRemoval of Implantable Devices
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 202748d
    Last ReviewSep 2, 2026
    Next Review DateN/A
    Key ActionObtain prior authorization through the online tool for participating providers serving Medicare Advantage members.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2Product categories addressed
    RequiredMedicare Advantage prior authorization
    RecommendedCommercial prior authorization
    2Removal-only pathways
    Not medically necessary

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Reimplantation after non-medically necessary implantation

    Medical Necessity Criteria

    Removal Only

    Removal only of a surgically implanted device is considered medically necessary when either of the following pathways is satisfied:

    Qualifying removal-only indication

    • Medically necessary initial insertion: The insertion of the device was determined to be medically necessary.

    • Non-medically necessary insertion with qualifying complication

      • Initial insertion: The insertion of the device was determined to be not medically necessary.

      • Qualifying indication

        • Complication: A complication is present.
        • Infection: An infection is present.

    Removal and Reinsertion, Replacement or Revision

    When the applicable CPT code represents removal together with reinsertion, replacement, or revision, each component must be reviewed separately:

    Combined removal and device intervention: The removal component must meet the removal criteria, and the reinsertion, replacement, or revision component must separately meet medical-necessity criteria.

    In most instances, use the criteria from the Medical Necessity policy for reinsertion, replacement, or revision. A policy specific to the device, or the New Technology and Miscellaneous Services policies, may apply instead.

    Reimplantation of the device is not medically necessary when the initial implantation was determined to be not medically necessary.

    When the initial implantation was determined to be not medically necessary, subsequent reimplantation of the device is also considered not medically necessary.

    Authorization and Denial Considerations

    Prior Authorization

    Confirm authorization by product type

    Prior authorization is required for Medicare Advantage Plans and recommended for Commercial Products. For participating providers, authorization is obtained via the online tool.

    Denial Risk

    Document a qualifying removal indication

    Removal-only is not medically necessary when the initial insertion was determined to be not medically necessary and neither a complication nor an infection is present.

    Denial Risk

    Verify the initial implantation was medically necessary

    Policy Summary
    PayerBlue Cross Blue Shield - Rhode Island
    PolicyRemoval of Implantable Devices
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 202748d
    Last ReviewSep 2, 2026
    Next Review DateN/A
    Key ActionObtain prior authorization through the online tool for participating providers serving Medicare Advantage members.
    SourceLink
    On This Page
    Medical Necessity CriteriaAuthorization and Denial Considerations

    Reimplantation is considered not medically necessary when the initial implantation was determined to be not medically necessary.