Medicare AdvantagePrior AuthMedium impact
Correction: Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Feb. 1
BCBS Michigan·MI·Prior Authorization
Effective date
Feb 1, 2026
We identified it
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.
Action Required
By January 31, 2026: Billing team must update prior authorization requirements in billing system and encounter workflows. Specifically: (1) Remove prior authorization requirement for CPT 87798 for BCN Advantage members only—it continues to require prior auth for Blue Care Network commercial members; (2) Remove prior authorization requirements for HCPCS codes M0237, M0238, and Q0237 for BCN Advantage members. Update internal documentation and provider alerts to clarify the distinction between BCN Advantage and Blue Care Network commercial plan requirements. Verify system changes are deployed before the effective date to prevent unnecessary prior authorization requests and potential claim processing delays.