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

January 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: 

C7566 C7571 J0162 J0654 J1073 J1736 J1737 J1837 J2516 J2596 J3291 J3376 J3379

The following code(s) will be covered if used as part of a covered service and will be separately reimbursed for Professional and Institutional providers for both Medicare Advantage Plans and Commercial Products: 

C9176

The following code(s) will be covered and separately reimbursed at no cost share for Institutional providers and Professional providers for Medicare Advantage Plans and Commercial Products:

J7299

The following code(s) will be covered and Informational Only as they are related to quality measures and are for informational purposes for CMS: 

M1426 M1427 M1428 M1429 M1430 M1431 M1432 M1433 M1434 M1435 M1436 M1437 M1438 M1439 M1440 M1441 M1442 M1443 M1444 M1445 M1446 M1447 M1448 M1449 M1450 M1451 M1452 M1453 M1454 M1455 M1456 M1457 M1458 M1459 M1460 M1461 M1462 M1463 M1464 M1465 M1466 M1467 M1468 M1469 M1470 M1471 M1472 M1473

M1474 M1475 M1476 M1477 M1478 M1479 M1480 M1481 M1482 M1483 M1484 M1485

M1486 M1487 M1488 M1489 M1490 M1491 M1492 M1493 M1494 M1495 M1496 M1497

M1498 M1499 M1500 M1501 M1502 M1503

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: 

J7528 

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: 

Q4398 Q4399 Q4400 Q4401 Q4402 Q4403 Q4404 Q4405 Q4406 Q4407 Q4408 Q4409 Q4410 Q4411 Q4412 Q4413 Q4414 Q4415 Q4416 Q4417 Q4420

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 

C1607 C1608 C7567 C7568 C7569 C9810 C9811 C9812 C9813 C9814 C9815 C9816 C9817 G0571

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

A4295 A4296 A4297

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: 

C7570 G0568 G0569 G0570 G0660 G0661 G0662 G0663 G0664 G0665 G0666 G0667 G0668 G9871 J2711 Q4431 Q4432 Q4433

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

C9307 C9308 J0013 J3387 J3389 J9184 J9256 J9282 J9326 Q5160