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Correction: Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Feb. 1
Act
by Jan 31, 2026
Effective date
Feb 1, 2026
Identified
Jul 23, 2026
Summary
Blue Cross and BCN have corrected prior authorization requirements effective Feb. 1, 2026. CPT code 87798 no longer requires prior authorization for BCN Advantage members (but continues to require it for Blue Care Network commercial members). HCPCS codes M0237, M0238, and Q0237 no longer require prior authorization for BCN Advantage members.
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What to do
by Jan 31, 2026 · 5 steps
01Billing team must update prior authorization requirements in billing system and encounter workflows.
02Remove prior authorization requirement for CPT 87798 for BCN Advantage members only—it continues to require prior auth for Blue Care Network commercial members.
03Remove prior authorization requirements for HCPCS codes M0237, M0238, and Q0237 for BCN Advantage members.
04Update internal documentation and provider alerts to clarify the distinction between BCN Advantage and Blue Care Network commercial plan requirements.
05Verify system changes are deployed before the effective date to prevent unnecessary prior authorization requests and potential claim processing delays.
Codes mentioned
87798M0237M0238Q0237
Original notice
Correction: Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Feb. 1
bcbsm.com · Always check the source before changing claims.