CommercialBilling CodesMedium impact
Important Updates to Policies, Provider Handbook, Preventive Guide, and Codes
Blue Cross Blue Shield of Vermont·VT·Provider News
Effective date
Nov 1, 2026
We identified it
Sep 1, 2026
Summary
Blue Cross and Blue Shield of Vermont is implementing routine code maintenance changes effective November 1, 2026. CPT code 87636 (a new code) will now require medical necessity documentation and will be processed as a single unit designation. This change affects laboratory testing claims and may impact prior authorization requirements.
Action Required
By October 31, 2026: Billing team must update billing system configuration to enforce medical necessity requirements and single unit designation for CPT 87636. Update claim scrubbing rules to flag claims with multiple units for CPT 87636. Notify providers that CPT 87636 claims submitted on or after November 1, 2026 require documented medical necessity or claims will be denied. Update fee schedules if applicable. Verify laboratory billing workflows reflect the new unit designation rules.