Medicare AdvantageBilling CodesHigh impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island has implemented new HCPCS Level II code changes effective January 1, 2023, affecting coverage rules, medical review requirements, and reimbursement policies. Multiple codes now require medical review, are not separately reimbursed, or require alternate codes for billing.
Action Required
Immediately: Billing team must update system rules for affected HCPCS codes - configure C7504, C7505, C7507, C7508 for medical review (Medicare Advantage) and mark as not medically necessary (Commercial). Set J0225, J2327, J9314, Q5126 to require medical review for both plan types. Mark codes A4239, C1826, C1827, E2103, C1747, C7902, G0322, G0323, G3002, G3003 as not separately reimbursed. Replace codes C7900, C7901, G0320, G0321, G0330, C9144 with alternate codes in billing software. Claims will be denied without proper authorization or alternate coding.