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Florida BlueCommercial · Coverage · Medical Policy · FL · Radiology, OB-GYN, Oncology +2 moreMedium impact

2026 Breast Cancer Screening Coverage Updates

Effective date
Jan 1, 2026
Identified
Jun 16, 2026

Summary

Effective January 1, 2026, Florida Blue and Truli for Health will expand preventive breast cancer screening coverage for women 40+ to include additional imaging (MRI, ultrasound, additional mammography) and pathology evaluation with $0 member cost share when needed to complete screening or investigate initial mammogram findings. Prior authorization will still be required for breast MRI.

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What to do

Action · 3 steps
01Before January 1, 2026: Billing team must update system to recognize expanded preventive breast cancer screening coverage for Florida Blue and Truli members with commercial plans.
02Configure billing rules to process additional imaging (MRI, ultrasound, mammography) and pathology evaluations using diagnosis codes Z12.31, Z12.39, Z80.3 with procedure code 88305 as preventive services with $0 copay for women 40+.
03Ensure prior authorization workflows remain in place for breast MRIs.

Codes mentioned

Z12.31Z12.39Z80.388305

Original notice

2026 Breast Cancer Screening Coverage Updates
files.guidewell.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Florida Blue policiesFL policy changesRadiologyOB-GYNOncologyFamily MedicineInternal MedicineCode Z12.31Code Z12.39Code Z80.3Code 88305

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