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Additional HCPCS Level II Code Changes and Modifier Changes
Act
by Apr 1, 2025
Effective date
Apr 1, 2025
Identified
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.
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What to do
by Apr 1, 2025 · 6 steps
01Billing team must update claims processing system with new HCPCS code coverage rules.
02Stop billing codes E1022, E1023 as they are not covered.
03Route codes C9301, C9302, C9303, J1299, J2351, J9024, J9038, J9054, J9161, Q2057, Q5147-Q5152, Q9999 through pharmacy benefit.
04Obtain prior authorization for codes C8004, C8005, G0183, G0566 for Medicare Advantage plans.
05Update billing software to reflect different reimbursement rules for professional vs institutional providers.
06Notify patients of non-covered services before rendering care.
Codes mentioned
A2030A2031A2032A2033A2034A2035A9611C9300E0201G0567L0720L1933L1952L6028L6029L6030L6031L6032L6033L6037E1032E1033E1034J0281J1072J1271J1308J1808J1938J2428J2804J2865S4024A6515A6516A6517A6518A6519A6611L7406A9154C9304J7521Q4354Q4355Q4356Q4357Q4358Q4359Q4360Q4361Q4362Q4363Q4364Q4365Q4366Q4367E1832L5827L6700C8004C8005G0183G0566E1022E1023C9301C9302C9303J1299J2351J9024J9038J9054J9161Q2057Q5147Q5148Q5149Q5150Q5151Q5152Q9999
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 PoliciesHighEffective Apr 1, 2025 · Physician / FacilityPayment Policy UpdatesHighEffective Jul 1, 2025 · Physician / FacilityMedical policy updatesHighEffective Jul 1, 2026 · Physician / FacilityMedical policy updatesHighEffective Jun 1, 2026 · 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 changesOrthopedicsOncologyWound CareCode A2030Code A2031Code A2032Code A2033Code A2034Code A2035Code A9611Code C9300Code E0201Code G0567Code L0720Code L1933Code L1952Code L6028Code L6029Code L6030Code L6031Code L6032Code L6033Code L6037Code E1032Code E1033Code E1034Code J0281Code J1072Code J1271Code J1308Code J1808Code J1938Code J2428Code J2804Code J2865Code S4024Code A6515Code A6516Code A6517Code A6518Code A6519Code A6611Code L7406Code A9154Code C9304Code J7521Code Q4354Code Q4355Code Q4356Code Q4357Code Q4358Code Q4359Code Q4360Code Q4361Code Q4362Code Q4363Code Q4364Code Q4365Code Q4366Code Q4367Code E1832Code L5827Code L6700Code C8004Code C8005Code G0183Code G0566Code E1022Code E1023Code C9301Code C9302Code C9303Code J1299Code J2351Code J9024Code J9038Code J9054Code J9161Code Q2057Code Q5147Code Q5148Code Q5149Code Q5150Code Q5151Code Q5152Code Q9999