All PlansPrior AuthHigh impact
Prior Authorization Changes to Oncology-related Codes
Highmark·Oncology, Radiation Oncology·Provider Bulletin
Effective date
May 1, 2026
We identified it
Feb 23, 2026
Summary
Effective May 1, 2026, Highmark is adding 115 oncology-related codes to their prior authorization requirement list, including common chemotherapy medications and radiation therapy procedures. All authorization requests for these codes must be submitted electronically through Availity Essentials and will be reviewed by Evolent as part of Highmark's oncology value-based care strategy.
Action Required
By May 1, 2026: Billing team must update billing system to require prior authorization for all 115 listed oncology codes before submitting claims to Highmark. Set up electronic authorization requests through Availity Essentials portal. Update encounter forms and EMR templates to alert providers that prior auth is required for these chemotherapy and radiation therapy codes. Train staff on new authorization workflow with Evolent. Claims submitted without prior authorization will be denied.