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Medicare AdvantageCoverageHigh impact

Additional HCPCS Level II Code Changes and Modifier Changes

Blue Cross Blue Shield of Rhode Island·RI · Oncology, Orthopedics, PM&R (Physical Medicine & Rehab)·Physician / Facility
Effective date
Apr 1, 2024
We identified it
Jun 19, 2026
Days to comply

Summary

Blue Cross Blue Shield of Rhode Island has updated coverage and payment rules for multiple HCPCS Level II codes effective April 1, 2024. The changes include new covered codes, non-covered codes, and codes requiring medical review, with different rules for Commercial and Medicare Advantage plans.

Action Required

Action needed
Immediately: Billing team must update system with new HCPCS code coverage rules effective April 1, 2024. Configure prior authorization requirements for codes G0138, J0177, J0589, J1202, J1203, J1323, J2782, J3055, J9248, C9168, J9249, J9376, Q5133, Q5134, and L5841. Mark codes E0152, E2298, H0051, A4293, S9002 as non-covered. Update encounter forms to alert providers about non-covered services notification requirements. Note that codes C9166, C9167, J2277 will require medical review starting May 1, 2024.

Affected Billing Codes

J0209
J0577
J0578
J0650
J0651
J0652
J1010
J1434
J2801
J2919
J3424
J7165
J7354
J9073
J9074
J9075
A9293
E0152
E2298
H0051
A4293
S9002
G0138
J0177
J0589
J1202
J1203
J1323
J2782
J3055
J9248
C9168
J9249
J9376
Q5133
Q5134
C9166
C9167
J2277
L5841
A4438
A4593
A4594
E0736
E0738
E0739
K1037
A4271
E2104
C9796
C9797
Q4305
Q4306
Q4307
Q4308
Q4309
Q4310
A2026
E0468
S4988
A4564
L1320
L5783