Summary
Capital Blue Cross updated its medical policies, with most changes effective July 1, 2026 unless otherwise indicated. Prior authorization for Loargys and Exdensur now applies to J3590 and C9399 starting July 1, 2026, and the PA requirement for Exdensur moved from a 6/1 date to 7/1. Many revised medical injectable policies take effect August 1, 2026, and several policies remove procedure codes that will now be managed by EviCore.
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What to do
Action · 9 steps
01Already effective July 1, 2026: Check whether prior authorization is required for Loargys and Exdensur under J3590 and C9399 for commercial plans.
02Submit medical injectable requests online through the Prime MPS GatewayPA Portal at http://www.GatewayPA.com, clicking Capital Blue Cross under Clinical Guidelines.
03For urgent or expedited requests, call Prime at 800.424.1710.
04If preauthorization cannot be done online, Prime accepts requests by phone at 800.424.1710 or by fax at 888.656.6671.
05Check the Capital Blue Cross Single source preauthorization list on the CapBlueCross.com provider page for codes that require preauthorization.
06Check each individual drug medical policy for the length of authorization, since prior authorization periods for some drugs have changed.
07Review the draft medical policies in the Provider Library under the Preauthorization and policies section for updated criteria and coding.
08Requests for codes removed from the listed policies will now be managed by EviCore.
09Check current applicability before acting, since the policies revised effective August 1, 2026 are also past their effective date.
Codes mentioned
J3590C9399815178159683520838838278583516860018600386005860088616086332863438684988375G0249P9020869999753381302813038130481321813228132396041S026583987697146971669729
Original notice
AB2026-06-004 Medical policies
capbluecross.com · Always check the source before changing claims.
Related changes
See all Capital Blue Cross changes →AB2026-11-005 Medical policiesHighEffective Dec 1, 2026 · Medical PolicyAB2026-09-005 Medical policiesHighEffective Oct 1, 2026 · Medical PolicyAB2026-08-005 Medical policiesHighEffective Sep 1, 2026 · Medical PolicyAB2026-07-005 Medical policiesHighEffective Aug 1, 2026 · Medical PolicyBrowse every Capital Blue Cross change in the policy list
Related policy hubs
Capital Blue Cross policiesOncologyHematologyGeneticsPharmacyAllergy & ImmunologyPulmonologyNeurologyBariatric SurgeryCardiologyENT (Ear, Nose & Throat)AudiologyDentistryOral & Maxillofacial SurgeryOB-GYNDermatologyOphthalmologyGastroenterologyNeurosurgeryPathologyInternal MedicineEndocrinologyWound CarePediatricsPsychiatryCardiothoracic SurgeryPlastic SurgeryOrthopedicsCode J3590Code C9399Code 81517Code 81596Code 83520Code 83883Code 82785Code 83516Code 86001Code 86003Code 86005Code 86008Code 86160Code 86332Code 86343Code 86849Code 88375Code G0249Code P9020Code 86999Code 97533Code 81302Code 81303Code 81304Code 81321Code 81322Code 81323Code 96041Code S0265Code 83987Code 69714Code 69716Code 69729