Medicare AdvantageCoverageHigh impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Apr 1, 2026
We identified it
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.
Action Required
By April 1, 2026: Billing team must update claims processing system with new HCPCS coverage rules. Stop billing codes A8005, A8006, A9294 as they are now non-covered. Obtain prior authorization for codes C8007, C8008, C8011, C8012, C9309, J1553, J9003, J9278, J9601, Q5161, Q5162. Use Modifier 22 with code Q0238 for coverage. Route codes C1743, C8010, G0680, L2221 to medical review for Medicare Advantage plans. Update billing software to reflect pharmacy benefit only for code C9818. Notify members about non-covered services prior to rendering them to avoid billing issues.