See Changes to Coverage for Breast Cancer Screening
AI Summary
Effective January 1, 2026, Blue Cross Blue Shield of Texas will cover breast cancer screening services (mammograms, MRIs, CT scans, contrast ultrasounds, biopsies, and pathology evaluations) as preventive care at no cost for members without a current breast cancer diagnosis. Members with existing breast cancer diagnoses will have cost-sharing for these services.
Action Required
Before January 1, 2026: Billing team must verify eligibility and benefits through Availity Essentials or preferred vendor prior to rendering breast cancer screening services to determine if no-cost preventive coverage applies. Update billing workflows to distinguish between screening services for members without breast cancer diagnosis (bill as preventive with no cost-sharing) versus diagnostic services for members with existing breast cancer diagnosis (bill with applicable cost-sharing). Train front desk staff to verify member's current breast cancer diagnosis status before scheduling.
Plan Types
Commercial
States
TX
Specialties
radiology, oncology, ob-gyn, family-medicine, internal-medicine, pathology