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Capital Blue CrossCommercial · Prior Auth · Provider News · Orthopedics, Cardiology, Pain Management +3 moreHigh impact

AB2026-03-001 Updates and new information

Effective date
May 1, 2026
Identified
Jun 20, 2026

Summary

Capital Blue Cross postponed the February 23, 2026 launch of an enhanced electronic process for appeals and medical records through the provider portal, and until a new launch date is announced, it continues to accept appeals by mail or fax. Effective May 1, 2026, new preauthorization requirements apply for Commercial and Medicare Advantage members, including codes C7568, C7569, C7570, C7571, 22526 and 22527 on the single source preauthorization list, cardiac procedures reviewed by TurningPoint (cardiac catheter ablations and percutaneous transcatheter cardiac defect closures), and an expanded set of musculoskeletal procedures reviewed by TurningPoint, covering ankle, elbow, wrist and shoulder procedures, implantable infusion pumps and spinal cord neurostimulators. Effective April 1, 2026, reimbursement policy FP-01.001 added the Uniform Billing Editor as a nationally accepted standards resource, and effective May 1, 2026, licensed genetic counselors can bill code 96041 for telehealth for Commercial and CHIP members.

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What to do

Action · 8 steps
01Already effective April 1, 2026: Apply reimbursement policy FP-01.001 Correct Coding and Reimbursement Methodology, which now lists the Uniform Billing Editor as a nationally accepted standards resource.
02Already effective May 1, 2026: Obtain preauthorization for codes C7568, C7569, C7570, C7571, 22526 and 22527 for Commercial and Medicare Advantage members, and use the Capital Blue Cross Single source preauthorization list to identify the codes that require preauthorization.
03For brain and neck computed tomography angiography, Evolent applies new medical policy CG-2068 to utilization management, and the policy is linked from Capital's medical policies page.
04For cardiology, obtain preauthorization through TurningPoint for cardiac catheter ablation codes 93580, 93653, 93654 and 93656 for Commercial and Medicare Advantage members, and review policies CA-1020 and CA-1021.
05For musculoskeletal services, obtain preauthorization through TurningPoint for the ankle, elbow, wrist, shoulder, implantable infusion pump and spinal cord neurostimulator codes listed for Commercial and Medicare Advantage members, and review policies OR-1021, OR-1030, OR-1022, OR-1033, OR-1032, OR-1015 and OR-1034.
06For Commercial members, thermal intradiscal procedures fall under TurningPoint policy OR-1039, which is investigational.
07Licensed genetic counselors can bill code 96041 for telehealth place of service for Commercial and CHIP members, and the genetic counseling reimbursement policy NR-30.022 pays code 96041 for each 30 minutes of total time the genetic counselor provides on the date of the telehealth encounter.
08Until Capital announces the new launch date for the electronic appeals and medical records process, continue submitting appeals by mail or fax.

Codes mentioned

C7568C7569C7570C7571225262252793580936539365493656277002770227703277042786027870298922989924160241642430024360243612436224363243652436624370243712533225441254422544325444254452544625449258002580525810258202582523040230442310023101231052310623107298052980629807298192982029821298222982329824298252982862350623516236062361623626236562367623686236962370C1772C1891C2626E0782E0783E0785E07866365063655636616366263663636646368563688C1767C1778C1787C1816C1820C1822C1897L8679L8680L8681L8682L8683L8685L8686L8687L8688L8689L869596041

Original notice

AB2026-03-001 Updates and new information
capbluecross.com · Always check the source before changing claims.
View original ↗

Related changes

See all Capital Blue Cross changes →
AB2026-01-003 Medical policiesHighNo effective date · Medical PolicyAB2026-01-001 Updates and new informationHighEffective Mar 1, 2026 · Provider NewsAB2026-05-006 Medical policiesHighEffective Jun 1, 2026 · Medical PolicyAB2026-06-004 Medical policiesHighEffective Jul 1, 2026 · Medical PolicyBrowse every Capital Blue Cross change in the policy list

Related policy hubs

Capital Blue Cross policiesOrthopedicsCardiologyPain ManagementNeurosurgeryRadiologyGeneticsCode C7568Code C7569Code C7570Code C7571Code 22526Code 22527Code 93580Code 93653Code 93654Code 93656Code 27700Code 27702Code 27703Code 27704Code 27860Code 27870Code 29892Code 29899Code 24160Code 24164Code 24300Code 24360Code 24361Code 24362Code 24363Code 24365Code 24366Code 24370Code 24371Code 25332Code 25441Code 25442Code 25443Code 25444Code 25445Code 25446Code 25449Code 25800Code 25805Code 25810Code 25820Code 25825Code 23040Code 23044Code 23100Code 23101Code 23105Code 23106Code 23107Code 29805Code 29806Code 29807Code 29819Code 29820Code 29821Code 29822Code 29823Code 29824Code 29825Code 29828Code 62350Code 62351Code 62360Code 62361Code 62362Code 62365Code 62367Code 62368Code 62369Code 62370Code C1772Code C1891Code C2626Code E0782Code E0783Code E0785Code E0786Code 63650Code 63655Code 63661Code 63662Code 63663Code 63664Code 63685Code 63688Code C1767Code C1778Code C1787Code C1816Code C1820Code C1822Code C1897Code L8679Code L8680Code L8681Code L8682Code L8683Code L8685Code L8686Code L8687Code L8688Code L8689Code L8695Code 96041

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