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Upcoming Policies effective September 1, 2025
Blue Cross and Blue Shield of Minnesota·Oncology, ENT (Ear, Nose & Throat), Radiology +1 more·Medical Policy
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
Effective September 1, 2025, revised policies for PET/PET-CT scans in oncology, balloon sinus dilation, and functional endoscopic sinus surgery (FESS) include updated medical necessity criteria and prior authorization requirements. All three procedures now require specific clinical documentation and have defined experimental/investigative exclusions.
Action Required
By September 1, 2025: Billing team must update prior authorization workflows for PET/PET-CT oncology scans, balloon sinus dilation, and FESS procedures. Update encounter forms to ensure providers document required clinical criteria including CT imaging results, failed medical management for minimum 12 weeks, and specific symptoms. Train staff on experimental/investigative exclusions to prevent claim denials.