We have completed our review of the April 2025 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, 2025. 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 2025 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 Professional providers and not separately reimbursed for Institutional Providers for both Medicare Advantage Plans and Commercial Products: 

A2030 A2031 A2032 A2033 A2034 A2035 A9611 C9300 E0201 G0567 L0720 L1933 L1952 L6028 L6029 L6030 L6031 L6032 L6033 L6037 

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

E1032 E1033 E1034 J0281 J1072 J1271 J1308 J1808 J1938 J2428 J2804 J2865 

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: 

S4024 

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

A6515 A6516 A6517 A6518 A6519 A6611 L7406  

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: 

A9154 C9304 J7521   

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: 

Q4354 Q4355 Q4356 Q4357 Q4358 Q4359 Q4360 Q4361 Q4362 Q4363 Q4364 Q4365 Q4366 Q4367 

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: 

E1832 L5827 L6700 

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 

C8004 C8005 G0183 G0566 

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

E1022 E1023 

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

C9301 C9302 C9303 J1299 J2351 J9024 J9038 J9054 J9161 Q2057 Q5147 Q5148 Q5149 Q5150 Q5151 Q5152 Q9999