CommercialCoverageMedium impact
Medical Policy Updates for December 2026
Blue Cross Blue Shield of Massachusetts·MA · Cardiology, Urology, Genetics +3 more·Medical Policy
Effective date
Sep 1, 2026
We identified it
Sep 2, 2026
Summary
This policy update affects five specialties with changes effective September 1, 2026 through December 1, 2026. Key changes include: (1) CPT codes 0338T and 0339T added to Renal Denervation policy with no prior auth required; (2) Genetic testing codes 81265 and 81266 no longer require prior authorization (effective September 19, 2026); (3) CA 125 test now covers BRCA1, BRCA2, and Lynch Syndrome indications; (4) Serum Tumor Markers policy expanded to include medullary thyroid cancer; (5) Ferric Carboxymaltose replaces Injectafer in Medicare Advantage Step Therapy. All changes require no provider action and prior authorization is not required for affected services.
Action Required
By September 1, 2026: Billing team must update systems to remove prior authorization requirement for Ferric Carboxymaltose (Medicare Advantage Part B Step Therapy policy 020) and remove Injectafer from coverage. By September 19, 2026: Update billing system to reflect that CPT codes 81265 and 81266 no longer require prior authorization for all products. By December 1, 2026: Update system edits and claim processing for CPT codes 0338T and 0339T (Renal Denervation) to reflect no prior authorization required; ensure CA 125 test (Policy 503) processes without prior auth for new indications (BRCA1, BRCA2, Lynch Syndrome); update Serum Tumor Markers policy (Policy 538) to process claims for medullary thyroid cancer indication without prior auth. Notify billing and clinical staff that these policy changes require no proactive provider actions. Update internal policy reference documentation to reflect new covered indications and code additions.