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Medicare AdvantageBilling CodesMedium impact

HCPCS Level II Code Changes and Modifier Changes April 2023

Blue Cross Blue Shield of Rhode Island·RI · Oncology·Physician / Facility
Effective date
Apr 1, 2023
We identified it
Jun 19, 2026
Days to comply

Summary

Blue Cross Blue Shield of Rhode Island updated HCPCS Level II codes and modifiers effective April 2023, with some codes becoming covered/reimbursed, others requiring medical review, and several not covered or separately reimbursed. Multiple effective dates apply with some changes taking effect May 1, 2023.

Action Required

Action needed
By April 1, 2023: Billing team must update system to bill codes C9145, J0612, J0613, J9196 as covered and separately reimbursed for both Medicare Advantage and Commercial plans. Stop billing K1035 as it is not covered. By April 1, 2023: Obtain prior authorization for codes C9146, C9147, C9148, J0218, J1449, J1747, Q5127, Q5128, Q5129, Q5130 for Commercial plans only. By May 1, 2023: Obtain prior authorization for codes C9149, J0208, J1411, J9294, J9296, J9297 for Commercial plans and Medicare Advantage plans. Update billing software to prevent separate billing of codes A2019, A2020, A2021, J2403, Q4265-Q4271, S9563, E0711 as they are bundled into other services.

Affected Billing Codes

C9145
J0612
J0613
J9196
K1035
C9146
C9147
C9148
J0218
J1449
J1747
Q5127
Q5128
Q5129
Q5130
C9149
J0208
J1411
J9294
J9296
J9297
A4341
A4342
A4560
A7049
E1905
A2019
A2020
A2021
J2403
Q4265
Q4266
Q4267
Q4268
Q4269
Q4270
Q4271
S9563
E0711
A6590
A6591
E0677
L8678
M0010