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AB2026-07-001 Updates and new information
Effective date
Not stated in the notice
Identified
Jul 1, 2026
Summary
Effective August 1, 2026, high-tech radiology and cardiac imaging services no longer need preauthorization for CHIP, and most no longer need it for Medicare Advantage, while a listed set of Medicare Advantage heart PET and stress echo codes moves to preauthorization through Capital; Commercial imaging stays with Evolent. Effective September 1, 2026, Capital will no longer reimburse specified codes for Commercial, codes 69209, 76376 and 76377 for Commercial and Medicare Advantage, and new obstetric reimbursement policy FP-01.011 begins, moving the first prenatal visit to E/M codes with modifier TH. Rabies vaccine 90675 became separately reimbursable in Urgent Care settings effective May 22, 2026.
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What to do
Action · 20 steps
01Already effective August 1, 2026: Confirm that the high-tech radiology and cardiac imaging codes no longer needing preauthorization for CHIP and Medicare Advantage are no longer being held for preauthorization.
02For Medicare Advantage, the codes that still require preauthorization through Capital are 78459, 78491, 78492, 78429, 78430, 78431, 78432, 78433, 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78481, 78483, 78499, 93350 and 93351, so get preauthorization through Capital for these.
03For Commercial, high-tech radiology and cardiac imaging continues to require preauthorization through Evolent.
04Check the Capital Single source preauthorization list for the full set of codes requiring preauthorization.
05The Evolent Medicare Advantage imaging policies listed in the bulletin retired from the Medicare medical policy library effective August 1, 2026.
06Already effective August 1, 2026: Confirm that V2785 no longer requires preauthorization for Commercial and Medicare Advantage.
07Already effective September 1, 2026: For Medicare Advantage, J1577, J3405, J1289, J9053, J9067, J2361, Q5165, Q5166, Q5167, Q5168, Q5169, Q5170 and Q5171 require preauthorization.
08Confirm that the practice has stopped billing 99374, 99375, G0179, G0180, G0181, G0574, G0575, G0669, G0670, G0671, G0672, G0673, G0676 and G0677 for Commercial, and 69209, 76376 and 76377 for Commercial and Medicare Advantage, since Capital will no longer reimburse them.
09NR-30.029 Services not Separately Reimbursed retires August 31, 2026, and FP-01.008 Services Not Separately Reimbursed takes effect September 1, 2026, with new codes added and applying to both Facility and Professional providers.
10Already effective September 1, 2026: For the first prenatal visit after confirmation of pregnancy, bill E/M codes with HCPCS modifier TH and ICD-10-CM codes including weeks of gestation (Z3A.XX), and document medical decision-making or time consistent with CPT guidelines.
11Providers are responsible for documentation that reflects the patient's severity and the services rendered.
12Future transition January 1, 2027: Under FP-01.011, labor management codes 59080-59083, 59030 and 59051 move from global-based to visit or service-based billing.
13The initial day of labor management may be reported once per facility admission unless a different provider furnishes services, and multiple visits by the same provider in the same setting on one calendar date are reported as a single service.
14Delivery care codes 59431-59504 may be reported on the same day as labor management.
15Postpartum codes 59623, 59610 and 59350, or the appropriate E/M codes, apply, and routine postpartum care on the delivery date is included in the delivery care code.
16For facility births, subsequent hospital care E/M codes apply for each management day until discharge, plus the applicable discharge day management codes.
17Already effective July 1, 2026: Revised contraceptive devices and supplies preventive coverage to include J7299.
18Providers are reminded to reference the Preventive Services Health Coverage Guidelines on Availity Essentials under Resources, Provider Library, Education and manuals, Guidelines.
19Already effective May 22, 2026: Professional providers in Urgent Care settings can receive separate reimbursement for rabies vaccine 90675, which was previously bundled into the global urgent care payment rate.
20All existing billing and documentation requirements remain unchanged, so continue to follow current guidelines for coding, compliance and claim processing.
Codes mentioned
703367045070460704707047170473704807048170482704867048770488704907049170492704967049870540705427054370544705457054670547705487054970551705527055370554705557125071260712707127571550715517155271555721257212672127721287212972130721317213272133721417214272156721467214772157721487214972158721597219172192721937219472195721967219772198732007320173202732067321873219732207322173222732237322573700737017370273706737187371973720737217372273723737257415074160741707417574174741767417774178741817418274183741857426174262747127555775559755617556375571S80927557275573756357638076390763917704677047770487704977084784727847378494786087860978803788307883178832788117881278813788147881578816933039330493306933079330893312933139331493315933169331793318G0219G025278459784917849278429784307843178432784337845178452784537845478466784687846978481784837849993350933519937499375G0179G0180G0181G0574G0575G0669G0670G0671G0672G0673G0676G06776920976376763775942559426590805908359030590515943159504596235961059350J7299V2785J1577J3405J1289J9053J9067Q5165Q5171Q5166Q5167J2361Q5168Q5169Q5170J338690675
Original notice
AB2026-07-001 Updates and new information
capbluecross.com · Always check the source before changing claims.
Related changes
See all Capital Blue Cross changes →AB2026-11-002 Medicare onlyHighEffective Jan 1, 2027 · Provider NewsAB2026-08-002 Medicare onlyHighEffective Sep 1, 2026 · Provider NewsAB2026-07-005 Medical policiesHighEffective Aug 1, 2026 · Medical PolicyAB2026-11-005 Medical policiesHighEffective Dec 1, 2026 · Medical PolicyBrowse every Capital Blue Cross change in the policy list
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