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Additional HCPCS Level II Code Changes and Modifier Changes
Act
by Jul 1, 2025
Effective date
Jul 1, 2025
Identified
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island has updated coverage and reimbursement rules for specific HCPCS Level II codes effective July 1, 2025. The changes include new codes that will be covered and separately reimbursed, codes subject to medical review requiring preauthorization, and codes reimbursed only under pharmacy benefits.
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What to do
by Jul 1, 2025 · 2 steps
01Billing team must update system to reflect new coverage rules - ensure J0165, J0166, J0167, J0168, J0169, J0616, J0618, J1163, J2312, J2313, J3373, J3374, J3375 are set for separate reimbursement; configure J7356 and J7172 to bill pharmacy benefits only; set up prior authorization requirements for C9174, C9175, J1326, J3391, J9174, J9275, J9276, J9289, J9341, J9342, J9382, Q2058, Q5098, Q5099, Q5100, Q5153; update encounter forms to alert providers of preauthorization requirements.
02Notify members about non-covered services prior to rendering them as required for participating providers.
Codes mentioned
J9220J0165J0166J0167J0168J0169J0616J0618J1163J2312J2313J3373J3374J3375J7356J7172Q4368Q4369Q4370Q4371Q4372Q4373Q4375Q4376Q4377Q4378Q4379Q4380Q4382C9174C9175J1326J3391J9174J9275J9276J9289J9341J9342J9382Q2058Q5098Q5099Q5100Q5153
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 →Additional HCPCS Level II Code Changes and Modifier ChangesMediumEffective Oct 1, 2026 · Physician / FacilityCPT® and HCPCS Level II code changesHighEffective Jan 1, 2019 · Physician / FacilityAdditional CPT and HCPCS Level II code changesMediumEffective Jan 1, 2019 · Physician / FacilityAdditional CPT and HCPCS Level II code changesMediumEffective Jul 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 changesOncologyWound CareCode J9220Code J0165Code J0166Code J0167Code J0168Code J0169Code J0616Code J0618Code J1163Code J2312Code J2313Code J3373Code J3374Code J3375Code J7356Code J7172Code Q4368Code Q4369Code Q4370Code Q4371Code Q4372Code Q4373Code Q4375Code Q4376Code Q4377Code Q4378Code Q4379Code Q4380Code Q4382Code C9174Code C9175Code J1326Code J3391Code J9174Code J9275Code J9276Code J9289Code J9341Code J9342Code J9382Code Q2058Code Q5098Code Q5099Code Q5100Code Q5153