Blue Cross Blue Shield of MassachusettsCommercial · Coverage · Medical Policy · MA · Cardiology, Urology, Genetics +3 moreMedium impact
Medical Policy Updates for December 2026
Act
by Sep 1, 2026
Effective date
Sep 1, 2026
Identified
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.
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01Billing 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.
02By September 19, 2026: Update billing system to reflect that CPT codes 81265 and 81266 no longer require prior authorization for all products.
03By 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.
04Notify billing and clinical staff that these policy changes require no proactive provider actions.
05Update internal policy reference documentation to reflect new covered indications and code additions.
Codes mentioned
8126581266
Original notice
Medical Policy Updates for December 2026
bluecrossma.org · Always check the source before changing claims.
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What is PolicyChanges
One workspace for payer rules, prior auth, coding and compliance
Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.