Medicare AdvantageBilling CodesHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Rheumatology·Physician / Facility
Effective date
Jul 1, 2023
We identified it
Jun 19, 2026
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.
Action Required
Immediately: Billing 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. Update billing software to flag codes J1941 and Q5131 as pharmacy benefit only. Stop separately billing codes C9150, Q4272-Q4284 (institutional only), and require alternate codes for C9151 (professional providers). Notify patients about non-covered services before rendering care.