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

October 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: 

C9311 C9312 C9313 J0871 J1957 J1958 J3268 J7524 J7526 J7529 J7530 J7531 J9187 J9192 J0014

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 

A6614 E2403

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

G0685

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: 

A2049 Q4207 Q4223 Q4243

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

A2046 A2047 A2048 A2050 A4228 A9613 E0788 L8697

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

J0643 J0644 J1757 J1818 J1946 J1947 J3406 J9066 J9186 J9191 J9362 Q5172 Q5173

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:

L1330 L1972