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Additional HCPCS Level II Code Changes and Modifier Changes
Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated HCPCS Level II code coverage and payment rules effective April 1, 2026. Multiple codes have new coverage designations including newly covered codes, non-covered codes, medical review requirements, and pharmacy benefit changes.
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What to do
by Apr 1, 2026 · 7 steps
01Billing team must update claims processing system with new HCPCS coverage rules.
02Stop billing codes A8005, A8006, A9294 as they are now non-covered.
03Obtain prior authorization for codes C8007, C8008, C8011, C8012, C9309, J1553, J9003, J9278, J9601, Q5161, Q5162.
04Use Modifier 22 with code Q0238 for coverage.
05Route codes C1743, C8010, G0680, L2221 to medical review for Medicare Advantage plans.
06Update billing software to reflect pharmacy benefit only for code C9818.
07Notify members about non-covered services prior to rendering them to avoid billing issues.
Codes mentioned
Q0238C8013J0463J1098J1164J8502M0233M0234A8005A8006A9294A2040A2041A2042A2043A2044A2045C8007C8008C8011C8012C9309J1553J9003J9278J9601Q5161Q5162C9818Q4418Q4419Q4421Q4422Q4423Q4424Q4425Q4426Q4427Q4428Q4429Q4435Q4436Q4437Q4438Q4439Q4440C1743C8010G0680L2221A4318A4479A6548L5992G0681G0682G0683G0684J3404J9183J9277
Original notice
Additional HCPCS Level II Code Changes and Modifier Changes
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Payment policy updatesMediumEffective Jan 1, 2026 · Physician / FacilityMedical policy updatesHighEffective Jun 1, 2026 · Physician / FacilityMedical policy updatesMediumEffective Dec 1, 2026 · Physician / FacilityHCPCS Code C8010MediumEffective Apr 1, 2026 · PhysicianBrowse 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 changesCode Q0238Code C8013Code J0463Code J1098Code J1164Code J8502Code M0233Code M0234Code A8005Code A8006Code A9294Code A2040Code A2041Code A2042Code A2043Code A2044Code A2045Code C8007Code C8008Code C8011Code C8012Code C9309Code J1553Code J9003Code J9278Code J9601Code Q5161Code Q5162Code C9818Code Q4418Code Q4419Code Q4421Code Q4422Code Q4423Code Q4424Code Q4425Code Q4426Code Q4427Code Q4428Code Q4429Code Q4435Code Q4436Code Q4437Code Q4438Code Q4439Code Q4440Code C1743Code C8010Code G0680Code L2221Code A4318Code A4479Code A6548Code L5992Code G0681Code G0682Code G0683Code G0684Code J3404Code J9183Code J9277