Medicare AdvantagePrior AuthMedium impact
Prior Authorization Changes for Some Government Program Members
BCBS New Mexico·NM · Cardiology, Diagnostic Imaging·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 18, 2026
Summary
BCBSNM is removing some prior authorization requirements for government program members starting July 1, 2026, including cardiology codes, lab/misc codes for Medicare Advantage, and advanced imaging for Medicaid Turquoise Care. New miscellaneous codes will require prior auth starting August 1, 2026 for Medicare Advantage members.
Action Required
By June 30, 2026: Billing team must update prior authorization workflows to remove requirements for cardiology codes (Medicare Advantage), lab/miscellaneous codes (Medicare Advantage), and advanced imaging codes (Medicaid Turquoise Care). By July 31, 2026: Add prior authorization requirements for new miscellaneous codes for Medicare Advantage members. Always verify current prior auth requirements through Availity Essentials before rendering services. Services performed without required prior authorization may be denied.