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AB2026-05-002 Medicare only
Act
by Jun 1, 2026
Effective date
Jun 1, 2026
Identified
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.
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What to do
by Jun 1, 2026 · 3 steps
01Update billing system to remove preauthorization requirements for codes E0270, E1250, E1260, E1285, E1290, G0219, G0252, T2007 for Medicare Advantage plans.
02By July 1, 2026: Update system to require preauthorization for injection codes J3404, J9183, J9277, J9278, Q5161, Q5162 for Medicare Advantage plans.
03Immediately: 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.
Codes mentioned
J3404J9183J9277J9278Q5161Q5162E0270E1250E1260E1285E1290G0219G0252T2007
Original notice
AB2026-05-002 Medicare only
capbluecross.com · Always check the source before changing claims.
Related changes
See all Capital Blue Cross changes →AB2026-08-002 Medicare onlyHighEffective Sep 1, 2026 · Provider NewsAB2026-07-001 Updates and new informationHighNo effective date · Provider NewsAB2026-11-005 Medical policiesHighEffective Dec 1, 2026 · Medical PolicyAB2026-11-002 Medicare onlyHighEffective Jan 1, 2027 · Provider NewsBrowse every Capital Blue Cross change in the policy list