Medicare AdvantageBilling CodesHigh impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Wound Care, Oncology·Physician / Facility
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated HCPCS Level II codes and modifiers effective October 1, 2025, affecting coverage and reimbursement rules for various procedures. Multiple codes now have different coverage policies for Professional vs Institutional providers, and some require specific modifiers or medical review.
Action Required
By October 1, 2025: Billing team must update claims processing system with new HCPCS coverage rules. Configure system to distinguish Professional vs Institutional provider billing for codes A2036-A2039, L1007, L5657, L6034-L6039. Add modifier 22 requirement for Q0235 and Q0237. Set up medical review flags for C1740-C1742, C8006, E0658-E0659, and pharmacy benefit codes. Update encounter forms to reflect coverage differences between Commercial and Medicare Advantage plans.