2026 Key Insurance Changes

Important payer updates impacting PT practice across Rhode Island

• BCBSRI Medicare Advantage (BlueCHiP & D-SNP): Prior authorization required starting 1/1/26 (via eviCore)
• BCBSRI Coding: Claims may be denied when using injury codes with 7th character “A”
  Modifier
• BCBS-RI – Continues to require correct use of Therapist Assistant Modifier – CQ
• Medicare Telehealth: Extended through December 31, 2027
• *Reminder: UHC RITE Care: Prior authorization requirement – Effective November 1st, 2025

  Bottom line: Strong documentation, accurate coding, and proactive authorization workflows are more important than ever.