CommercialPrior AuthMedium impact
Certain Treatments for Prostate Cancer Now Require Prior Authorization
CareFirst BlueCross BlueShield·Oncology, Urology·Prior Authorization
Effective date
Feb 1, 2024
We identified it
Jun 20, 2026
Summary
Starting February 1, 2024, CareFirst BlueCross BlueShield will require prior authorization for Xofigo (radium-223 dichloride) injection used to treat prostate cancer. This affects CPT code 79101 and HCPCS code A9606 for all commercial lines of business.
Action Required
By February 1, 2024: Billing team must update system to require prior authorization for CPT 79101 and HCPCS A9606 (Xofigo injection for prostate cancer) for all CareFirst commercial plans. Update encounter forms and EMR templates to alert providers. Review CareFirst's authorization training in the Learning and Engagement Center. Claims submitted without prior authorization will be denied.