We have completed our review of the October 2025 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, 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.

October 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.

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: 

A2036 A2037 A2038 A2039 L1007 L5657 L6034 L6035 L6036 L6038 L6039 

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

A9616 J0163 J0164 J0458 J0462 J0525 J0570 J0582 J0675 J0681 J0759 J1370 J1612 J1807 J1809 J1834 J2151 J2291 J3290 M0235 M0236 M0237 M0238 Q5156 

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: 

Q0235 Q0237 

The following code(s) will be covered and separately reimbursed at no cost share for Institutional providers and Professional providers for Commercial Products and covered and not separately reimbursed for Institutional providers and Professional providers for Medicare Advantage Plans only: 

A4288 

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: 

A9612 J0668 

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: 

J0738 J0752 J7173 J7174 

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: 

Q4383 Q4384, Q4385 Q4386 Q4387 Q4388 Q4389 Q4390 Q4391 Q4392 Q4393 Q4394 Q4395 Q4396 Q4397 

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 

C1740 C1741 C1742 C8006 

The following code(s) will be subject to medical review for Professional providers for Medicare Advantage Plans and Commercial Products (at no cost share for Commercial Products). Codes will be reimbursable to DME providers only for both Medicare and Commercial.

E0658 E0659 

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

E0150 

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

C9305 C9306 J0614 J3402 J3403 J9011 Q5154 Q5155 Q5157 Q5158 Q5159