CommercialCoverageMedium impact
2026 Breast Cancer Screening Coverage Updates
Florida Blue·FL · Radiology, OB-GYN, Oncology +2 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
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.
Action Required
Before 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. Configure 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+. Ensure prior authorization workflows remain in place for breast MRIs.