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HCPCS Level II Code Changes and Modifier Changes April 2023
Act
by Apr 1, 2023
Effective date
Apr 1, 2023
Identified
Jun 19, 2026
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.
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What to do
by Apr 1, 2023 · 5 steps
01Billing team must update system to bill codes C9145, J0612, J0613, J9196 as covered and separately reimbursed for both Medicare Advantage and Commercial plans.
02Stop billing K1035 as it is not covered.
03By April 1, 2023: Obtain prior authorization for codes C9146, C9147, C9148, J0218, J1449, J1747, Q5127, Q5128, Q5129, Q5130 for Commercial plans only.
04By May 1, 2023: Obtain prior authorization for codes C9149, J0208, J1411, J9294, J9296, J9297 for Commercial plans and Medicare Advantage plans.
05Update billing software to prevent separate billing of codes A2019, A2020, A2021, J2403, Q4265-Q4271, S9563, E0711 as they are bundled into other services.
Codes mentioned
C9145J0612J0613J9196K1035C9146C9147C9148J0218J1449J1747Q5127Q5128Q5129Q5130C9149J0208J1411J9294J9296J9297A4341A4342A4560A7049E1905A2019A2020A2021J2403Q4265Q4266Q4267Q4268Q4269Q4270Q4271S9563E0711A6590A6591E0677L8678M0010
Original notice
HCPCS Level II Code Changes and Modifier Changes April 2023
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Policy updatesHighEffective Aug 1, 2023 · Physician / FacilityPolicy updatesHighEffective Sep 1, 2023 · Physician / FacilityPolicy UpdatesHighEffective Oct 1, 2023 · Physician / FacilityAdditional HCPCS Level II Code Changes and Modifier ChangesMediumEffective Oct 1, 2026 · 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 changesOncologyCode C9145Code J0612Code J0613Code J9196Code K1035Code C9146Code C9147Code C9148Code J0218Code J1449Code J1747Code Q5127Code Q5128Code Q5129Code Q5130Code C9149Code J0208Code J1411Code J9294Code J9296Code J9297Code A4341Code A4342Code A4560Code A7049Code E1905Code A2019Code A2020Code A2021Code J2403Code Q4265Code Q4266Code Q4267Code Q4268Code Q4269Code Q4270Code Q4271Code S9563Code E0711Code A6590Code A6591Code E0677Code L8678Code M0010