High impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·Effective Sep 1, 2026
Arkansas Blue Cross updated IMRT breast cancer treatment coverage criteria effective 09/01/2026. The policy now specifies that standard whole breast irradiation (WBI) should be 15-16 fractions, with 17-28 fractions allowed only for specific clinical scenarios (nodal involvement, post-mastectomy/reconstruction, dose inhomogeneity, or concurrent chemotherapy). Breast boost limits also changed: up to 8 fractions for patients meeting extended WBI criteria, or up to 5 fractions for others. Billing teams must validate treatment plans against these new criteria to avoid claim denials.