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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Billing Codes · Physician / Facility · RI · Oncology, Endocrinology, CardiologyHigh impact

Additional HCPCS Level II Code Changes and Modifier Changes

Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jun 19, 2026

Summary

Blue Cross Blue Shield of Rhode Island has updated coverage and payment rules for multiple HCPCS Level II codes effective July 1, 2026. The changes include new codes that will be covered and separately reimbursed, codes requiring medical review, and codes that will be covered but not separately reimbursed.

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What to do

by Jul 1, 2026 · 5 steps
01Billing team must update claims processing system with new HCPCS code coverage rules.
02Add modifier 22 requirement for Q0234.
03Configure prior authorization requirements for J1289, J1577, J2361, J3386, J3405, J9053, J9062, Q5164-Q5171, and C1609 (Medicare Advantage only for C1609).
04Update system to prevent separate billing for A9574, C8014, G0574-G0678 as these are bundled services.
05Notify providers of medical review requirements and ensure members are informed of non-covered services before rendering them.

Codes mentioned

Q0234M0231M0232C9310J0528J2374J2789J7176J9232J1289J1577J2361J3386J3405J9053J9062Q5164Q5165Q5166Q5167Q5168Q5169Q5170Q5171C1609A9574C8014G0574G0575G0669G0670G0671G0672G0673G0674G0675G0676G0677G0678

Original notice

Additional HCPCS Level II Code Changes and Modifier Changes
bcbsri.com · Always check the source before changing claims.
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Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
Payment Policy UpdatesHighEffective Jul 1, 2026 · Provider UpdateAdditional HCPCS Level II Code Changes and Modifier ChangesMediumEffective Oct 1, 2026 · Physician / FacilityCPT® and HCPCS Level II code changesMediumEffective Jul 1, 2018 · Physician / FacilityCPT® and HCPCS Level II code changesHighEffective Jan 1, 2019 · Physician / FacilityBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list

Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesOncologyEndocrinologyCardiologyCode Q0234Code M0231Code M0232Code C9310Code J0528Code J2374Code J2789Code J7176Code J9232Code J1289Code J1577Code J2361Code J3386Code J3405Code J9053Code J9062Code Q5164Code Q5165Code Q5166Code Q5167Code Q5168Code Q5169Code Q5170Code Q5171Code C1609Code A9574Code C8014Code G0574Code G0575Code G0669Code G0670Code G0671Code G0672Code G0673Code G0674Code G0675Code G0676Code G0677Code G0678

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