Summary
Blue Cross Blue Shield of Rhode Island implemented July 2023 CPT code changes affecting coverage rules for numerous J-codes (drugs/biologics), C-codes (temporary procedures), and Q-codes (supplies). Many codes now require medical review/prior authorization, some are covered only under pharmacy benefits, and others are not separately reimbursed.
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What to do
immediately · 4 steps
01Billing team must update system to require prior authorization for codes C9151, J1440, J1576, J2329, J9029, J9056, J9058, J9059, J9063, J9347, J9380, J9381 for Medicare Advantage and Commercial plans, and J9350 for Commercial plans only.
02Update billing software to flag codes J1941 and Q5131 as pharmacy benefit only.
03Stop separately billing codes C9150, Q4272-Q4284 (institutional only), and require alternate codes for C9151 (professional providers).
04Notify patients about non-covered services before rendering care.
Codes mentioned
J0137J0206J0216J0457J0665J0736J0737J1805J1806J1811J1812J1813J1814J1836J1920J1921J1961J2249J2305J2371J2372J2427J2561J2598J2599J2806J7213J9259J9322J9323J1941Q5131C9151J1440J1576J2329J9029J9056J9058J9059J9063J9347J9380J9381J9350C9150C9784C9785C9786C9787Q4272Q4273Q4274Q4275Q4276Q4277Q4278Q4280Q4281Q4282Q4283Q4284
Original notice
CPT code changes
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Policy UpdatesHighEffective Oct 1, 2023 · Physician / FacilityCPT® and HCPCS Level II code changesMediumEffective Jul 1, 2018 · Physician / FacilityCPT® and HCPCS Level II code changesHighEffective Jan 1, 2019 · Physician / FacilityAdditional CPT and HCPCS Level II code changesMediumEffective Jul 1, 2019 · 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 changesOncologyRheumatologyCode J0137Code J0206Code J0216Code J0457Code J0665Code J0736Code J0737Code J1805Code J1806Code J1811Code J1812Code J1813Code J1814Code J1836Code J1920Code J1921Code J1961Code J2249Code J2305Code J2371Code J2372Code J2427Code J2561Code J2598Code J2599Code J2806Code J7213Code J9259Code J9322Code J9323Code J1941Code Q5131Code C9151Code J1440Code J1576Code J2329Code J9029Code J9056Code J9058Code J9059Code J9063Code J9347Code J9380Code J9381Code J9350Code C9150Code C9784Code C9785Code C9786Code C9787Code Q4272Code Q4273Code Q4274Code Q4275Code Q4276Code Q4277Code Q4278Code Q4280Code Q4281Code Q4282Code Q4283Code Q4284