CommercialBilling CodesHigh impact
Payment Policy Updates
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
This policy contains three updates: (1) Telemedicine modifier claims (93, 95, FQ, GT) will be denied if billed with place of service codes other than 02 or 10, effective 9/1/26; (2) Thirteen new codes (A9574, C8014, G0574-G0678) are added as non-reimbursable for Commercial and Medicare Advantage plans effective 7/1/26; (3) Three COVID-19 treatment codes (M0231, M0232, Q0234) are added as covered and separately reimbursed effective 7/1/26.
Action Required
IMMEDIATE - Three separate actions required: (1) By September 1, 2026: Billing team must implement system edit to deny all claims containing telemedicine modifiers (93, 95, FQ, GT) if place of service is anything other than 02 or 10. Update provider education materials and encounter forms to clarify modifiers are only for telemedicine services. Providers submitting incorrect combinations will experience claim denials. (2) By July 1, 2026: Billing team must add codes A9574, C8014, and G0574-G0678 to the NSR (non-reimbursable) list in billing system for Commercial and Medicare Advantage plans. Configure system to deny claims with these codes automatically. Update fee schedules and encoder software. (3) By July 1, 2026: Billing team must activate reimbursement for codes M0231, M0232, and Q0234 in billing system for all lines of business. Configure these as separately payable administration codes and monoclonal antibody service code. Update fee schedules and provider communications. Billing software must reflect these changes in all three plan types before effective dates or claims will be denied or rejected.