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Additional HCPCS Level II Code Changes and Modifier Changes
Act
immediately
Effective date
Jul 1, 2024
Identified
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.
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What to do
immediately · 6 steps
01Update billing system for all affected HCPCS codes with new coverage rules.
02Set up prior authorization alerts for codes J2267, J3247, J3263, J3393, J3394, J7171, J9361, Q5138, and J7355.
03Redirect billing for J8611, J8612, J1748, Q5137 to pharmacy benefit only - do not bill medical.
04Stop billing G0529, G0530, G0531 as they are no longer covered.
05Update encounter forms to reflect codes that are covered but not separately reimbursed.
06Claims billed incorrectly will be denied or paid at $0.
Codes mentioned
C9901J0211J0687J0872J2183J2246J2373J2468J2470J2471A9506C1605C1606G0519G0520G0521G0522G0523G0524G0525G0526G0527G0528G9037G9038J0911J1597J1598G0529G0530G0531J2267J3247J3263J3393J3394J7171J9361Q5138J7355Q4311Q4312Q4313Q4314Q4315Q4316Q4317Q4318Q4319Q4320Q4321Q4322Q4323Q4324Q4325Q4326Q4327Q4328Q4329Q4330Q4331Q4332Q4333J8611J8612J1748Q5137
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 Policy UpdatesHighEffective Jul 1, 2025 · Physician / FacilityProvider notification: iDose TR (J7355) and Durysta (J7351)MediumEffective Sep 1, 2026 · Physician / FacilityProvider notification: iDose TR (J7355) and Durysta (J7351)MediumEffective Sep 1, 2026 · Physician / FacilityProvider Notification: iDose TR (J7355) and Durysta (J7351)MediumEffective Sep 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 changesCode C9901Code J0211Code J0687Code J0872Code J2183Code J2246Code J2373Code J2468Code J2470Code J2471Code A9506Code C1605Code C1606Code G0519Code G0520Code G0521Code G0522Code G0523Code G0524Code G0525Code G0526Code G0527Code G0528Code G9037Code G9038Code J0911Code J1597Code J1598Code G0529Code G0530Code G0531Code J2267Code J3247Code J3263Code J3393Code J3394Code J7171Code J9361Code Q5138Code J7355Code Q4311Code Q4312Code Q4313Code Q4314Code Q4315Code Q4316Code Q4317Code Q4318Code Q4319Code Q4320Code Q4321Code Q4322Code Q4323Code Q4324Code Q4325Code Q4326Code Q4327Code Q4328Code Q4329Code Q4330Code Q4331Code Q4332Code Q4333Code J8611Code J8612Code J1748Code Q5137