Medicare AdvantageBilling CodesHigh impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Oncology, Wound Care·Physician / Facility
Effective date
Apr 1, 2025
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, 2025. The changes affect over 60 codes with varying coverage status including separately reimbursed, not covered, pharmacy benefit only, and requiring medical review across different provider types.
Action Required
By April 1, 2025: Billing team must update claims processing system with new HCPCS code coverage rules. Stop billing codes E1022, E1023 as they are not covered. Route codes C9301, C9302, C9303, J1299, J2351, J9024, J9038, J9054, J9161, Q2057, Q5147-Q5152, Q9999 through pharmacy benefit. Obtain prior authorization for codes C8004, C8005, G0183, G0566 for Medicare Advantage plans. Update billing software to reflect different reimbursement rules for professional vs institutional providers. Notify patients of non-covered services before rendering care.