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BCBS TexasMedicare Advantage · Administrative · Pharmacy · TX · OncologyHigh impact

Claims Review to Be Enhanced for Oncology Drugs and Services for Government Programs, Effective June 1, 2025

Act
by Jun 1, 2025
Effective date
Jun 1, 2025
Identified
Jan 12, 2026

Summary

Effective June 1, 2025, enhanced claims review will be implemented for oncology drugs and associated services for Medicare Advantage and Medicaid members. Claims lacking appropriate procedure and diagnosis codes will face delays or denials, requiring strict adherence to standard coding guidelines including ICD-10, HCPCS, and CPT codes.

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What to do

by Jun 1, 2025 · 3 steps
01Billing team must ensure all oncology drug claims for Medicare Advantage and Medicaid members include accurate procedure and diagnosis code combinations per ICD-10, HCPCS, and CPT guidelines.
02Review current oncology billing workflows and update staff training on proper coding requirements.
03Inaccurately coded claims will result in denied or delayed payment.

Original notice

Claims Review to Be Enhanced for Oncology Drugs and Services for Government Programs, Effective June 1, 2025
bcbstx.com · Always check the source before changing claims.
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BCBS Texas policiesTX policy changesOncology

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