We have completed our review of the April 2026 Healthcare Common Procedure Coding System (HCPCS) changes and Modifier changes. These updates will be added to our claims processing system and are effective April 1, 2026. The lists include code that have special coverage or payment rules for standard Products. (Some employers may customize their benefits.) We have included codes for services that are:

• “Not covered” this includes services not covered in the main member certificate (e.g., covered as a prescription drug).
• “Not medically necessary “for Commercial and “Not Covered” for Medicare Advantage Plans this indicates services where there is insufficient evidence to determine the effects of the technology on health outcomes. 
• “Not separately reimbursed” – services that are not separately reimbursed are generally included in payment for another service or are reported using another code and may not be billed to your patient.
• “Subject to medical review” – preauthorization is recommended for Commercial Products and required for Medicare Advantage Plans.
• “Individual Consideration review”- services that require supporting documentation filed with the claim for review.
• “Use Alternate Code”- services that require the use of an alternate code that is addressed in an existing policy.

Please submit your comments and concerns regarding coverage and payment designations to:

Blue Cross & Blue Shield of Rhode Island

Attention: Medical Policy, HCPCS Review

500 Exchange Street

Providence, Rhode Island 02903

Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them.

April 2026 HCPCS Updates:

Please note: Coverage and/or payment rules for code(s) below may be subject to change for Medicare Advantage Plans and/or Commercial Products.

The following code(s) will be covered and separately reimbursed for Institutional providers and Professional providers for both Medicare Advantage Plans and Commercial Products when submitted with Modifier 22: 

Q0238

The following code(s) will be covered and separately reimbursed for Institutional providers and Professional providers for both Medicare Advantage Plans and Commercial Products: 

C8013 J0463 J1098 J1164 J8502 M0233 M0234

The following code(s) will be not covered for Institutional providers and Professional providers for both Commercial Products and Medicare Advantage Plans: 

A8005 A8006

The following code(s) will be not covered for Institutional providers and Professional providers for both Commercial Products and Medicare Advantage Plans: 

A8005 A8006 A9294

The following code(s) will be covered and separately reimbursed for Professional providers and not separately reimbursed for Institutional Providers for both Medicare Advantage Plans and Commercial Products: A2040 A2041 A2042 A2043 A2044 A2045

The following code(s) will be subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and Commercial Products 

C8007 C8008 C8011 C8012

The following code(s) will be subject to medical review for Professional and Institutional providers (Pharmacy Benefit) for Commercial Products and Medicare Advantage Plans:

C9309 J1553 J9003 J9278 J9601 Q5161 Q5162

The following code(s) will be reimbursed under the Pharmacy Benefit Only for both Professional and Institutional providers for Commercial Products and Medicare Advantage Plans: 

C9818

The following code(s) will be covered when filed with a covered diagnosis and will not be separately reimbursed for Institutional providers only for Medicare Advantage Plans and Commercial Products: 

Q4418 Q4419 Q4421 Q4422 Q4423 Q4424 Q4425 Q4426 Q4427 Q4428 Q4429 Q4435 Q4436 Q4437 Q4438 Q4439 Q4440

The following code(s) will be subject to medical review for Professional and Institutional providers for Medicare Advantage Plans and are not medically necessary for Professional and Institutional providers for Commercial Products 

C1743 C8010 G0680 L2221

The following code(s) will be covered for both Medicare Advantage Plans and Commercial Products and will only be reimbursable to DME providers only for Medicare and Commercial Products

A4318 A4479 A6548 L5992

The following code(s) will be covered and not separately reimbursed for Institutional providers and Professional providers for Commercial Products and Medicare Advantage Plans only: 

G0681 G0682 G0683 G0684

The following code(s) will be subject to medical review for Professional and Institutional providers (Pharmacy Benefit) for Commercial Products and will be covered for Medicare Advantage Plans:

J3404 J9183 J9277