← Back to list
Medical Policy and Coding Updates - June 2026
Act
by Sep 19, 2026
Effective date
Sep 19, 2026
Identified
Jun 16, 2026
Summary
Carelon Medical Benefits Management has updated clinical appropriateness guidelines for radiology, sleep disorder management, and genetic testing, expanding coverage criteria for many imaging studies and diagnostic tests. Multiple policies also updated medical necessity criteria for procedures like negative pressure wound therapy and orthognathic surgery.
Get alerts when payers change rules like this one
We check Premera Blue Cross and other payers every day and email you when a change matches your specialty and state.
Get Premera Blue Cross alertsPolicy Monitoring is free. No card required.
What to do
by Sep 19, 2026 · 4 steps
01Billing and prior authorization teams must review and update internal guidelines to align with new Carelon appropriateness criteria.
02Key changes include expanded CT cerebral perfusion indications, new allowances for extremity imaging without repeat x-rays for osteomyelitis, updated cardiac imaging criteria, and modified genetic testing requirements.
03Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for specific guideline documentation.
04Update prior authorization workflows to reflect new coverage criteria to prevent claim denials.
Original notice
Medical Policy and Coding Updates - June 2026
premera.com · Always check the source before changing claims.
Related changes
See all Premera Blue Cross changes →Medical Policy and Coding Updates - November 2026HighEffective Nov 1, 2026 · Medical PolicyMedical Policy and Coding Updates - November 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - October 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - September 2026HighNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list