We have completed our review of the July 2025 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, 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.

July 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 if used as part of a covered service and separately reimbursed for Professional providers and not separately reimbursed for Institutional Providers for both Medicare Advantage Plans and Commercial Products: 

J9220 

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

J0165 J0166 J0167 J0168 J0169 J0616 J0618 J1163 J2312 J2313 J3373 J3374 J3375 

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: 

J7356 J7172   

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: 

Q4368 Q4369 Q4370 Q4371 Q4372 Q4373 Q4375 Q4376 Q4377 Q4378 Q4379 Q4380 Q4382 

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

C9174 C9175 J1326 J3391 J9174 J9275 J9276 J9289 J9341 J9342 J9382 Q2058 Q5098 Q5099 Q5100 Q5153