CommercialCoverageHigh impact
CPT code changes
Blue Cross Blue Shield of Rhode Island·RI · Oncology·Physician / Facility
Effective date
Jul 1, 2020
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island updated CPT/HCPCS code coverage rules effective July 1, 2020. Multiple codes now require prior authorization, are not covered, or are deemed not medically necessary, with different rules for commercial vs. BlueCHiP Medicare products.
Action Required
Immediately: Billing team must update system settings for affected BCBS Rhode Island claims. Configure prior authorization requirements for codes Q5119, Q5120, Q5121, J1558, C9061, C9063, J0223, J0791, J0896, J3399, J9177, J9198, J9246, J935, and J1429 based on plan type. Mark codes J0591, C9122, and J7333 as non-covered/not medically necessary. Update encounter forms to alert providers about non-covered services that must be disclosed to patients before rendering care.