Medicare AdvantageBilling CodesHigh impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·RI · Oncology, Endocrinology, Cardiology·Physician / Facility
Effective date
Jul 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island has updated coverage and payment rules for multiple HCPCS Level II codes effective July 1, 2026. The changes include new codes that will be covered and separately reimbursed, codes requiring medical review, and codes that will be covered but not separately reimbursed.
Action Required
By July 1, 2026: Billing team must update claims processing system with new HCPCS code coverage rules. Add modifier 22 requirement for Q0234. Configure prior authorization requirements for J1289, J1577, J2361, J3386, J3405, J9053, J9062, Q5164-Q5171, and C1609 (Medicare Advantage only for C1609). Update system to prevent separate billing for A9574, C8014, G0574-G0678 as these are bundled services. Notify providers of medical review requirements and ensure members are informed of non-covered services before rendering them.