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Blue Cross Blue Shield of Rhode IslandMedicare Advantage · Coverage · Physician / Facility · RIHigh impact

Additional CPT and HCPCS Level II code changes

Act
immediately
Effective date
Jan 1, 2020
Identified
Jun 19, 2026

Summary

Blue Cross Blue Shield of Rhode Island updated CPT and HCPCS code coverage and payment rules effective January 1, 2020. Multiple codes now have restrictions including not covered, not medically necessary, not separately reimbursed, or require medical review for BlueCHiP Medicare and commercial products.

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What to do

immediately · 2 steps
01Billing team must update system rules to stop billing non-covered codes (K1003, K1004, 20560, 20561, 80145, 80230, 80280, 92549, C9758, K1001, K1002, K1005), remove non-separately reimbursed codes from billing (98970-98972, 99421-99423, 99458, 99473-99474, G2058, G2061-G2065, B4187, A4226, E2398, L8033), and implement preauthorization requirements for codes subject to medical review (78434, 78830-78832, 81277, 81307-81309, 81522, 81542, 93356, C9757, E0787, J9309, L2006).
02Update encounter forms and notify providers about non-covered services before rendering them to members.

Codes mentioned

K1003K1004205602056180145802308028092549C9758K1001K1002K1005989709897198972994219942299423994589947399474G2058G2061G2062G2063G2064G2065B4187A4226E2398L80337843478830788317883281277813078130881309815228154293356C9757E0787J9309L20069091290913C9055J9199

Original notice

Additional CPT and HCPCS Level II code changes
bcbsri.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross Blue Shield of Rhode Island changes →
Medical policy updatesHighEffective Mar 1, 2025 · PhysicianMedical policy updatesHighEffective Apr 1, 2025 · Physician / FacilityPolicy updatesHighEffective Sep 1, 2023 · Physician / FacilityPolicy updatesHighEffective Jun 1, 2023 · Provider UpdateBrowse 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 K1003Code K1004Code 20560Code 20561Code 80145Code 80230Code 80280Code 92549Code C9758Code K1001Code K1002Code K1005Code 98970Code 98971Code 98972Code 99421Code 99422Code 99423Code 99458Code 99473Code 99474Code G2058Code G2061Code G2062Code G2063Code G2064Code G2065Code B4187Code A4226Code E2398Code L8033Code 78434Code 78830Code 78831Code 78832Code 81277Code 81307Code 81308Code 81309Code 81522Code 81542Code 93356Code C9757Code E0787Code J9309Code L2006Code 90912Code 90913Code C9055Code J9199

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