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Site of Care Guidelines Expansion: Select Oncology and Non-Oncology Provider-Administered Medications
Florida Blue·FL · Oncology, Hematology, Endocrinology +3 more·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jun 23, 2026
Summary
Florida Blue is expanding Site of Care Guidelines effective July 1, 2026, requiring select oncology immunotherapies (when used as monotherapy) and non-oncology provider-administered medications to be given at alternative sites instead of outpatient hospital facilities unless specific criteria are met. This affects members whose benefit plans include comparative effectiveness in medical necessity definitions and will require prior authorization reviews to determine appropriate administration sites.
Action Required
By July 1, 2026: Billing team must update prior authorization processes for listed HCPCS codes to include site of care determination. Providers must initiate conversations with Florida Blue patients receiving these medications at hospital outpatient facilities before current prior authorizations expire. Contact Prime MPS at 1-800-424-4947 for transition assistance. Claims for hospital outpatient administration may be denied unless specific criteria are met (pediatric patients under 18, lack of alternative site access, distance >45 miles from alternatives, or documented clinical conditions requiring enhanced supervision).