Medicare AdvantagePrior AuthMedium impact
AB2026-05-002 Medicare only
Capital Blue Cross·Oncology, Radiology, PM&R (Physical Medicine & Rehab)·Provider News
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross Medicare Advantage plans will require preauthorization for 5 new injection codes starting July 1, 2026, while removing preauthorization requirements for 8 medical equipment and imaging codes starting June 1, 2026. The policy also provides important guidance on CMS RADV audit compliance and updated forms.
Action Required
By June 1, 2026: Update billing system to remove preauthorization requirements for codes E0270, E1250, E1260, E1285, E1290, G0219, G0252, T2007 for Medicare Advantage plans. By July 1, 2026: Update system to require preauthorization for injection codes J3404, J9183, J9277, J9278, Q5161, Q5162 for Medicare Advantage plans. Immediately: Ensure medical records retention compliance for 10 years and establish rapid response procedures for CMS RADV audit requests using provided secure portal, email, or fax methods.