What insurance policy changes affect HCPCS J9601?

There are 14 tracked policy changes affecting HCPCS J9601, including updates from BCBS Michigan, Health Net, Blue Cross Blue Shield of Rhode Island. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J9601?

Payers that have issued tracked updates for HCPCS J9601 include: BCBS Michigan, Health Net, Blue Cross Blue Shield of Rhode Island, Texas Medicaid, Kansas Medicaid (KanCare), Michigan Medicaid - MDHHS.

How do I get notified when HCPCS J9601 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J9601. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS J9601?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

J9601 Insurance Policy Changes

HCPCS J9601 is officially defined as "Injection, linvoseltamab-gcpt, 1 mg." HCPCS J9601 is referenced in 14 tracked payer policy changes from BCBS Michigan, Health Net, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9601 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact
We’re adding requirements for additional medical oncology drugs for most members, starting May 13
BCBS Michigan·Effective May 13, 2026
Starting May 13, 2026, Blue Cross Blue Shield of Michigan and Blue Care Network are adding prior authorization, site of care, and step therapy requirements for 7 medical oncology drugs administered in outpatient settings. Additionally, step therapy requirements for Anktiva are being expanded to require failure of two drugs instead of one.
High impact
Correction: We’re adding requirements for additional medical oncology drugs for most members, starting May 13
BCBS Michigan·Effective May 13, 2026
Blue Cross Blue Shield of Michigan is adding prior authorization, site of care, and step therapy requirements for seven medical oncology drugs effective May 13, 2026. The policy also updates step therapy requirements for Anktiva to require trying two drugs instead of one.
High impact
26-629 Updates to Prior Authorization Requirements
Health Net·Effective Apr 1, 2026
Community Health Plan of Imperial Valley updated prior authorization requirements with immediate changes for incontinence supplies (PA only required beyond 186 units/month or $165/month limit) and extensive new PA requirements effective April 1, 2026 for multiple categories including advanced imaging, genetic testing, pharmaceuticals, and skin substitutes.
High impact
26-630 Updates to Prior Authorization Requirements
Health Net·Effective Apr 1, 2026
Health Net has updated prior authorization requirements with immediate changes to Medi-Cal incontinence supplies (PA only required beyond 186 units/month or $165/month limit) and new PA requirements for multiple services including advanced imaging, genetic testing, neuro stimulators, medications, and orthotics effective April 1, 2026.
High impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island·Effective Apr 1, 2026
Blue Cross Blue Shield of Rhode Island updated HCPCS Level II code coverage and payment rules effective April 1, 2026. Multiple codes have new coverage designations including newly covered codes, non-covered codes, medical review requirements, and pharmacy benefit changes.
High impact
HCPCS 1st-quarter update: New, deleted codes
BCBS Michigan·Effective Apr 1, 2026
Blue Cross Blue Shield of Michigan has implemented its Q1 2026 HCPCS code updates, adding 56 new codes and deleting 6 codes effective April 1, 2026. Most new skin substitute codes (A2040-A2045, Q4418-Q4440) are not covered, while new drug/injection codes (J-codes) and COVID-19 related codes are generally covered.
High impact
First Quarter 2026 HCPCS Updates for Texas Medicaid
Texas Medicaid·Effective Apr 1, 2026
Texas Medicaid is implementing first quarter 2026 HCPCS updates effective April 1, 2026, adding new covered and non-covered procedure codes with specific age limitations and prior authorization requirements. Several existing codes are being discontinued with direct replacements required.
High impact
First Quarter 2026 HCPCS Updates for the CSHCN Services Program
Texas Medicaid·Effective Apr 1, 2026
Texas Medicaid CSHCN Services Program is implementing Q1 2026 HCPCS updates effective April 1, 2026. Multiple codes are being added as benefits (pending rate hearings), added as non-covered, or discontinued entirely. Several new codes require prior authorization and have age restrictions.
Medium impact
Additional medical benefit drugs will require prior authorization for Blue Cross commercial URMBT members
BCBS Michigan·Effective Jul 1, 2026
Starting July 1, 2026, six specific drugs (including Keytruda Qlex, Inlexzo, and others) will require prior authorization for Blue Cross commercial UAW Retiree Medical Benefits Trust members when administered in outpatient settings. Authorization requests must be submitted through designated portals before administration.
Medium impact
KMAP BULLETIN: HCPCS Codes Update – April 2026
Kansas Medicaid (KanCare)·Effective Apr 1, 2026
Kansas Medicaid (KMAP) is adding 13 new HCPCS codes for coverage and discontinuing 6 existing codes effective April 1, 2026. Billing teams must update their systems to use the new codes and stop billing the discontinued ones.
Medium impact
26-628 Updates to Prior Authorization Requirements
Health Net·Effective Apr 1, 2026
CalViva Health updated prior authorization requirements effective immediately for incontinence supplies (PA only required beyond 186 units/month or $165 benefit limit) and added PA requirements for multiple new services including genetic testing, advanced imaging for under 21, and various pharmaceuticals effective April 1, 2026.
Medium impact
26-631 Updates to Prior Authorization Requirements
Health Net·Effective Apr 1, 2026
LA-DHS Medi-Cal updated prior authorization requirements with immediate changes for incontinence supplies (PA only required beyond 186 units/month or $165/month limit) and new PA requirements effective April 1, 2026 for multiple services including genetic testing, gene therapy drugs, orthotics, prosthetics, and neuro stimulators.
Medium impact
HCPCS replacement codes established, effective April 1, 2026
BCBS Michigan·Effective Apr 1, 2026
CMS established new HCPCS codes for 8 specialty medical drugs effective April 1, 2026, replacing temporary codes. The billing team must update their systems to use the new permanent codes for all services performed on or after April 1, 2026, while continuing to use old codes for services through March 31, 2026.
Medium impact
MMP 26-15: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates
Michigan Medicaid - MDHHS·Effective Apr 1, 2026
Michigan Medicaid has updated CPT and HCPCS codes effective April 1, 2026, adding new covered codes for various provider types and discontinuing several existing codes. The policy also includes retroactive coverage for some codes back to January 1, 2026.

All billing codes J3590 99212 99213 99202 99211 99214

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

We’re adding requirements for additional medical oncology drugs for most members, starting May 13

Correction: We’re adding requirements for additional medical oncology drugs for most members, starting May 13

26-629 Updates to Prior Authorization Requirements

26-630 Updates to Prior Authorization Requirements

Additional HCPCS Level II Code Changes and Modifier Changes

HCPCS 1st-quarter update: New, deleted codes

First Quarter 2026 HCPCS Updates for Texas Medicaid

First Quarter 2026 HCPCS Updates for the CSHCN Services Program

Additional medical benefit drugs will require prior authorization for Blue Cross commercial URMBT members

KMAP BULLETIN: HCPCS Codes Update – April 2026

26-628 Updates to Prior Authorization Requirements

26-631 Updates to Prior Authorization Requirements

HCPCS replacement codes established, effective April 1, 2026

MMP 26-15: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates