Medicare AdvantageBilling CodesHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Apr 1, 2022
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated CPT codes effective April 1, 2022, with specific coverage rules including medical review requirements, non-covered services, and non-separately reimbursed codes. Several codes now require preauthorization for commercial and Medicare Advantage plans, while others are not covered or bundled into other services.
Action Required
Immediately: Billing team must update system to require preauthorization for codes C9091, C9093, J0491, J9273, J9359, Q5124 (effective April 1) and J0879 (effective May 1) for both commercial and Medicare Advantage plans. Update encounter forms to flag codes A9291, K1028-K1033 as not covered for Medicare Advantage and not medically necessary for commercial. Configure billing system to prevent separate billing of codes A2011-A2013, A4238, E2102, and A4100. V2525 requires special handling - only covered for pediatric vision eyewear on commercial plans.