Who is affected by this change?

This affects Blue Cross Blue Shield of Rhode Island Oncology, Hematology providers in RI on Medicare Advantage, Commercial, Traditional Medicare plans.

When does this change take effect?

This change is effective Jan 1, 2025.

What do I need to do?

By January 1, 2025: Billing team must update system to replace CAR-T therapy codes 0537T-0540T with new CPT codes 38225-38228 and submit directly to CMS (not separately reimbursed). Remove telemedicine codes 99441, 99442, 99443 from Medicare Advantage billing and code 96040 from all plans. Add code 96041 for Commercial plans only. Update system to deny all newly added NSR codes as non-reimbursable. Configure DME codes E1803-E1829 to process only for DME providers. Replace modifier JG with TB. Update encounter forms and train staff on code changes to prevent claim denials.

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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Billing Codes · Physician / Facility · RI · Oncology, HematologyHigh impact

Payment Policy Updates

Q: Which billing codes are affected?

The following codes are affected: 38225, 38226, 38227, 38228, 99441, 99442, 99443, 96040, 96041, 15011, 15012, 15013, 15014, 15015, 15016, 15017, 15018, 38204, 76014, 76015, 76016, 76017, 76018, 76019, 93896, 93897, 93898, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, C1737, C1738, G0534, G0535, G0536, G0537, G0538, G0544, G0546, G0547, G0548, G0549, G0550, G0551, G0552, G0553, G0554, G0556, G0557, G0558, G0559, G0560, H0052, H0053, J0666, J09601, Q4346, Q4347, Q4348, Q4349, Q4350, Q4351, Q4353, A9513, A9517, A9527, A9530, A9543, A9563, A9564, A9573, A9589, A9590, A9591, A9592, A9593, A9594, A9597, A9598, A9600, A9603, A9604, A9605, A9606, A9607, A9608, A9609, A9697, A9698, A9699, J1245, Q3001, Q9969, E1803, E1804, E1807, E1808, E1813, E1814, E1822, E1823, E1826, E1827, E1828, E1829, 00811.

Act

by Jan 1, 2025

Effective date

Jan 1, 2025

Identified

Jun 19, 2026

Summary

Multiple policy updates effective January 1, 2025: CAR-T therapy temporary codes (0537T-0540T) replaced with permanent CPT codes (38225-38228) but are not separately reimbursed, telemedicine code changes for Medicare Advantage and Commercial plans, and extensive list of codes added to non-reimbursable (NSR) list. Additional changes include new DME-only codes and modifier updates.

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What to do

by Jan 1, 2025 · 7 steps

01Billing team must update system to replace CAR-T therapy codes 0537T-0540T with new CPT codes 38225-38228 and submit directly to CMS (not separately reimbursed).

02Remove telemedicine codes 99441, 99442, 99443 from Medicare Advantage billing and code 96040 from all plans.

03Add code 96041 for Commercial plans only.

04Update system to deny all newly added NSR codes as non-reimbursable.

05Configure DME codes E1803-E1829 to process only for DME providers.

06Replace modifier JG with TB.

07Update encounter forms and train staff on code changes to prevent claim denials.

Codes mentioned

3822538226382273822899441994429944396040960411501115012150131501415015150161501715018382047601476015760167601776018760199389693897938989800098001980029800398004980059800698007980089800998010980119801298013980149801598016C1737C1738G0534G0535G0536G0537G0538G0544G0546G0547G0548G0549G0550G0551G0552G0553G0554G0556G0557G0558G0559G0560H0052H0053J0666J09601Q4346Q4347Q4348Q4349Q4350Q4351Q4353A9513A9517A9527A9530A9543A9563A9564A9573A9589A9590A9591A9592A9593A9594A9597A9598A9600A9603A9604A9605A9606A9607A9608A9609A9697A9698A9699J1245Q3001Q9969E1803E1804E1807E1808E1813E1814E1822E1823E1826E1827E1828E182900811

Original notice

Payment Policy Updates

bcbsri.com · Always check the source before changing claims.

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Additional CPT® Code Changes January 2025HighEffective Jan 1, 2025 · Physician / Facility CPT code changes for January 2025HighEffective Jan 1, 2025 · Physician / Facility Additional CPT® Code Changes January 2025HighEffective Jan 1, 2025 · Physician / Facility April 2017MediumNo effective date · Provider Update Browse every Blue Cross Blue Shield of Rhode Island change in the policy list

Related policy hubs

Blue Cross Blue Shield of Rhode Island policies RI policy changes Oncology Hematology Code 38225 Code 38226 Code 38227 Code 38228 Code 99441 Code 99442 Code 99443 Code 96040 Code 96041 Code 15011 Code 15012 Code 15013 Code 15014 Code 15015 Code 15016 Code 15017 Code 15018 Code 38204 Code 76014 Code 76015 Code 76016 Code 76017 Code 76018 Code 76019 Code 93896 Code 93897 Code 93898 Code 98000 Code 98001 Code 98002 Code 98003 Code 98004 Code 98005 Code 98006 Code 98007 Code 98008 Code 98009 Code 98010 Code 98011 Code 98012 Code 98013 Code 98014 Code 98015 Code 98016 Code C1737 Code C1738 Code G0534 Code G0535 Code G0536 Code G0537 Code G0538 Code G0544 Code G0546 Code G0547 Code G0548 Code G0549 Code G0550 Code G0551 Code G0552 Code G0553 Code G0554 Code G0556 Code G0557 Code G0558 Code G0559 Code G0560 Code H0052 Code H0053 Code J0666 Code J09601 Code Q4346 Code Q4347 Code Q4348 Code Q4349 Code Q4350 Code Q4351 Code Q4353 Code A9513 Code A9517 Code A9527 Code A9530 Code A9543 Code A9563 Code A9564 Code A9573 Code A9589 Code A9590 Code A9591 Code A9592 Code A9593 Code A9594 Code A9597 Code A9598 Code A9600 Code A9603 Code A9604 Code A9605 Code A9606 Code A9607 Code A9608 Code A9609 Code A9697 Code A9698 Code A9699 Code J1245 Code Q3001 Code Q9969 Code E1803 Code E1804 Code E1807 Code E1808 Code E1813 Code E1814 Code E1822 Code E1823 Code E1826 Code E1827 Code E1828 Code E1829 Code 00811

Payment Policy Updates

Summary

Get alerts when payers change rules like this one

What to do

Codes mentioned

Original notice

Related changes

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