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Capital Blue CrossCommercial · Prior Auth · Medical Policy · Oncology, Rheumatology, Dermatology +6 moreHigh impact

AB2026-05-006 Medical policies

Act
by Jun 1, 2026
Effective date
Jun 1, 2026
Identified
Jun 20, 2026

Summary

Capital Blue Cross is implementing major changes to medical specialty injectable policies and multiple medical policies. A new drug Exdensur will require prior authorization, over 30 injectable medications will have revised policies, and new prior authorization requirements are being added for bio-engineered skin substitutes and other procedures.

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What to do

by Jun 1, 2026 · 4 steps
01Update billing systems to require prior authorization for new drug Exdensur (codes J3590, C9399).
02By July 1, 2026: Review and update prior authorization workflows for 30+ revised injectable medication policies including Cimzia, Fasenra, Nucala, and others - submit requests via Prime MPS GatewayPA Portal or call 800.424.1710.
03Update systems to require PA for bio-engineered skin substitute codes 15271, 15273, 15275, 15277, 15011, 15013, 15015, 15017, G0681, G0683.
04Remove retired code J9295 (Portrazza) from billing systems.

Codes mentioned

J3590C9399J929522526225271527115273152751527715011150131501515017G0681G0683

Original notice

AB2026-05-006 Medical policies
capbluecross.com · Always check the source before changing claims.
View original ↗

Related changes

See all Capital Blue Cross changes →
AB2026-10-005 Medical policiesHighEffective Nov 1, 2026 · Medical PolicyAB2026-11-005 Medical policiesHighEffective Dec 1, 2026 · Medical PolicyAB2026-09-005 Medical policiesHighEffective Oct 1, 2026 · Medical PolicyAB2026-08-005 Medical policiesHighEffective Sep 1, 2026 · Medical PolicyBrowse every Capital Blue Cross change in the policy list

Related policy hubs

Capital Blue Cross policiesOncologyRheumatologyDermatologyGastroenterologyPulmonologyWound CarePain ManagementOrthopedicsPlastic SurgeryCode J3590Code C9399Code J9295Code 22526Code 22527Code 15271Code 15273Code 15275Code 15277Code 15011Code 15013Code 15015Code 15017Code G0681Code G0683

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