Medicare AdvantageBilling CodesHigh impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·RI·Physician
Effective date
Oct 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated HCPCS Level II codes effective October 1, 2023, with varying coverage rules for Medicare Advantage and Commercial plans. Multiple codes now require prior authorization, alternate codes, or have specific coverage limitations that affect billing and reimbursement.
Action Required
Immediately: Update billing system to reflect October 2023 HCPCS changes. Configure prior authorization requirements for codes C9155, J2781, J9345 (all plans), J9051, J9064 (Commercial only), and C9157 (effective November 1, 2023). Set up alternate code requirements for J2781, C9790, C9791 for professional providers. Update system to route code A9156 to pharmacy benefit only. Configure non-reimbursement flags for multiple codes based on provider type and plan. Notify patients of non-covered services per provider agreement requirements.