Medicare AdvantageCoverageHigh impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated coverage and payment rules for 60+ HCPCS codes effective July 1, 2024. Key changes include new covered codes, codes moved to pharmacy benefit only, and codes subject to medical review or not separately reimbursed.
Action Required
Immediately: Update billing system for all affected HCPCS codes with new coverage rules. Set up prior authorization alerts for codes J2267, J3247, J3263, J3393, J3394, J7171, J9361, Q5138, and J7355. Redirect billing for J8611, J8612, J1748, Q5137 to pharmacy benefit only - do not bill medical. Stop billing G0529, G0530, G0531 as they are no longer covered. Update encounter forms to reflect codes that are covered but not separately reimbursed. Claims billed incorrectly will be denied or paid at $0.