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Policy Criteria Change-Material Amendment

Arkansas Blue Cross Blue Shield·AR · OB-GYN, Pediatrics, Rheumatology +5 more·Medical Policy
Effective date
Nov 1, 2026
We identified it
Aug 1, 2026
Days to comply
92 days

Summary

Arkansas Blue Cross revised coverage criteria for three laboratory testing policies effective 11/01/2026: (1) Nongenetic prenatal screening now covers only specific tests (blood type, Rh status, anemia, Group B strep, rubella, varicella immunity, and fetal fibronectin for preterm labor symptoms) with 40 procedure codes removed; (2) CRP/ESR inflammation testing expanded to cover 17 specific inflammatory conditions with defined frequency; (3) Alpha-1 antitrypsin testing removed 2 codes with no coverage criteria changes. Billing teams must identify and deny claims for removed codes and non-covered indications.

Action Required

Before Nov 1, 2026
By October 15, 2026: Billing team must update billing system to deny or reject all claims for the 42 removed procedure codes (81001, 81002, 81003, 81007, 81015, 82677, 82947, 82950, 82951, 82962, 83036, 86480, 86580, 86592, 86593, 86631, 86632, 86704, 86706, 86780, 86803, 86804, 87077, 87081, 87086, 87088, 87110, 87270, 87320, 87340, 87341, 87389, 87490, 87491, 87494, 87590, 87591, 87800, 87810, 87850, G0472, 82542, 83789) when billed to Arkansas Blue Cross. For prenatal screening (Policy 2024030): Configure system to deny hCG testing for normal uncomplicated pregnancies and salivary hormone preterm labor testing; allow only blood type, Rh status, antibody testing, CBC/hemoglobin screening, Group B strep (weeks 36-37), rubella antibody, varicella immunity testing, and fetal fibronectin (for symptomatic preterm labor in ambulatory settings). For inflammation testing (Policy 2024051): Update system to require specific ICD-10 diagnosis codes matching the 17 covered inflammatory conditions and enforce frequency limits (e.g., arthritis 1-3 months initially then 6-12 months; rheumatoid arthritis prior to treatment, every 1-3 months during active disease, annually when inactive). Implement logic to deny CRP/ESR for uncovered conditions, screening without abnormal findings, or general exams. Train billing staff and update claim submission templates. Providers must document medical necessity with appropriate diagnosis codes or claims will be denied.

Affected Billing Codes

81001
81002
81003
81007
81015
82677
82947
82950
82951
82962
83036
86480
86580
86592
86593
86631
86632
86704
86706
86780
86803
86804
87077
87081
87086
87088
87110
87270
87320
87340
87341
87389
87490
87491
87494
87590
87591
87800
87810
87850
G0472
82542
83789