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.
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What to do
immediately · 4 steps
01Billing 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.
02Update encounter forms to flag codes A9291, K1028-K1033 as not covered for Medicare Advantage and not medically necessary for commercial.
03Configure billing system to prevent separate billing of codes A2011-A2013, A4238, E2102, and A4100.
04V2525 requires special handling - only covered for pediatric vision eyewear on commercial plans.
Codes mentioned
C9091C9093J0491J9273J9359Q5124J0879J0219A4100A2011A2012A2013A4238E2102Q4224Q4225Q4256Q4257Q4258A9291K1028K1029K1031K1032K1033V2525
Original notice
CPT code changes
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 / FacilityUpdated Policies (outside of Annual review)HighEffective Aug 1, 2022 · Physician / FacilityMedical policy updatesHighEffective Oct 1, 2025 · 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 changesCode C9091Code C9093Code J0491Code J9273Code J9359Code Q5124Code J0879Code J0219Code A4100Code A2011Code A2012Code A2013Code A4238Code E2102Code Q4224Code Q4225Code Q4256Code Q4257Code Q4258Code A9291Code K1028Code K1029Code K1031Code K1032Code K1033Code V2525