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Medicare AdvantageCoverageHigh impact

Additional CPT and HCPCS Level II code changes

Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jan 1, 2020
We identified it
Jun 19, 2026
Days to comply

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.

Action Required

Action needed
Immediately: Billing 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). Update encounter forms and notify providers about non-covered services before rendering them to members.

Affected Billing Codes

K1003
K1004
20560
20561
80145
80230
80280
92549
C9758
K1001
K1002
K1005
98970
98971
98972
99421
99422
99423
99458
99473
99474
G2058
G2061
G2062
G2063
G2064
G2065
B4187
A4226
E2398
L8033
78434
78830
78831
78832
81277
81307
81308
81309
81522
81542
93356
C9757
E0787
J9309
L2006
90912
90913
C9055
J9199