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Important Updates to Policies and Codes
Blue Cross Blue Shield of Vermont·VT·Newsletter
Effective date
Oct 1, 2026
We identified it
Aug 4, 2026
Summary
This is a correction notice for two billing codes that require prior authorization effective October 1, 2026. Code J1289 requires prior approval through Optum Rx (correction to earlier guidance), and code 15879 requires prior approval per medical policy. Both codes were previously announced but contained incomplete information regarding prior authorization requirements.
Action Required
By September 30, 2026: Billing team must update billing system to require prior authorization for codes J1289 and 15879. Specifically: (1) J1289 must route prior authorization requests through Optum Rx; (2) 15879 must follow medical policy prior authorization requirements. Update encounter forms and provider templates to indicate prior auth is required for both codes. Configure system to flag and hold claims for these codes pending prior authorization approval. Providers should be notified of this requirement immediately. Claims submitted without prior authorization will be denied.