Back to dashboard
Medicare AdvantageBilling CodesHigh impact

Additional HCPCS Level II Code Changes and Modifier Changes

Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Oct 1, 2024
We identified it
Jun 19, 2026
Days to comply

Summary

Blue Cross Blue Shield of Rhode Island updated coverage and reimbursement rules for 47+ HCPCS Level II codes effective October 1, 2024. The changes include new covered codes with specific reimbursement rules for professional vs institutional providers, codes moved to pharmacy benefits, and several codes now requiring medical review or being deemed not covered.

Action Required

Action needed
Immediately: Billing team must update system rules for 47+ HCPCS codes with new coverage and reimbursement criteria. Key actions: (1) Configure codes A2027, A2028, A2029, A9610 as separately reimbursable for professional providers only, (2) Route codes J8522, J8541, Q0519, Q0520 to pharmacy benefits instead of medical billing, (3) Enable medical review requirements for codes C9169, C9170, C9172, J9329, Q5135, Q5136, (4) Mark codes A4543, E0721, A4545, E0715, E0716, E0737 as non-covered to prevent claim submission, (5) Update provider encounter forms and EMR templates to reflect new coverage rules. Providers must notify members about non-covered services prior to rendering them to avoid patient billing issues.

Affected Billing Codes

A2027
A2028
A2029
A9610
J0138
J1171
J1749
J2252
J2253
J2601
C8000
C9171
J2002
J2003
J2004
P9027
L1006
L1653
L1821
J8522
J8541
Q0519
Q0520
Q4334
Q4335
Q4336
Q4337
Q4338
Q4339
Q4340
Q4341
Q4342
Q4343
Q4344
Q4345
A4543
E0721
A4545
E0715
E0716
E0737
C9169
C9170
C9172
J9329
Q5135
Q5136
A4544
A7021
E2513
E3200
E0469
E0683
E0743
E0767
L8720
L8721