CommercialPrior AuthHigh impact
AB2026-08-001 Updates and new information
Capital Blue Cross·OB-GYN, Pathology, Oncology +4 more·Provider News
Effective date
Sep 1, 2026
We identified it
Jul 31, 2026
Summary
Capital Blue Cross issued a multi-topic administrative bulletin with four key changes: (1) new Availity electronic appeals training available, (2) new venipuncture reimbursement policy effective October 1, 2026 requiring separate lab facility billing, (3) retirement of global obstetrical policy with transition to visit-based billing September 1–December 31, 2026, and (4) updates to preauthorization requirements for specific chemotherapy and durable medical equipment codes across multiple plan types.
Action Required
IMMEDIATE (1 day old policy - HIGH PRIORITY): (1) By September 1, 2026: Providers must transition from global obstetrical billing (NR-05.601) to visit-based maternity billing (FP-01.011); update EMR templates and provider documentation to report prenatal, delivery, and postpartum services individually rather than as global packages; this affects all OB-GYN providers billing maternity services. Policy NR-05.601 will be retired December 31, 2026. (2) By October 1, 2026: Billing team must update system rules to deny separate venipuncture reimbursement (CPT 36415, 36416, 36591, 36592) when in-office lab tests are performed; venipuncture is now considered incidental to lab services and reimbursed only when specimens are sent to external laboratories. Update encounter forms and provider education. (3) By October 1, 2026: Billing team must add prior authorization requirements for Medicare Advantage plans for chemotherapy codes J9196 (Gemcitabine Hydrochloride) and J9045 (Carboplatin); update billing software to flag these codes for pre-auth submission. (4) By September 1, 2026: Remove prior authorization requirements from billing system for Commercial plans for codes E2513, S0812, S8950 and for Medicare Advantage for codes 17360, E0747, and for both plan types for codes E2626–E2633 (wheelchair accessories). (5) Optional: Encourage providers to access Availity Essentials appeals training (Help and Training > Get Trained > Catalog > Search 'Appeals' > Availity Appeals Training Demo—Non-Payer Specific course) to improve electronic appeals submission efficiency and reduce claim delays/dismissals.