CommercialCoverageHigh impact
Positron Emission Tomography (PET) Oncologic Applications 6.01.29
Excellus BlueCross BlueShield·Oncology, Radiology, Nuclear Medicine +1 more·Radiology (x-rays) & Imaging
Effective date
May 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their PET scan policy for oncologic applications, effective May 15, 2026. The policy provides detailed, cancer-specific criteria for when PET/CT imaging is considered medically appropriate for initial staging, restaging, and surveillance across 20+ cancer types including breast, lung, colorectal, and lymphoma.
Action Required
Before May 15, 2026: Review and update prior authorization protocols for PET/CT scans to align with new cancer-specific criteria. Providers must ensure documentation meets specific requirements for each cancer type (e.g., Stage III N2 for breast cancer, Stage II-III for anal cancer). Update encounter forms and EMR templates to include cancer staging information required for PET scan approval. Claims not meeting the detailed criteria will likely be denied.