We have completed our review of the July 2026 Healthcare Common Procedure Coding System (HCPCS) changes and Modifier changes. These updates will be added to our claims processing system and are effective July 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.

July 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: 

Q0234

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

M0231 M0232 C9310 J0528 J2374 J2789 J7176 J9232

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

J1289 J1577 J2361 J3386 J3405 J9053 J9062 Q5164 Q5165 Q5166 Q5167 Q5168 Q5169 Q5170 Q5171

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 

C1609

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: 

A9574 C8014 G0574 G0575 G0669 G0670 G0671 G0672 G0673 G0674 G0675 G0676 G0677

G0678