CommercialPrior AuthHigh impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Montana·MT · Oncology, Radiology, Orthopedics +1 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of Montana is implementing significant prior authorization changes for commercial and government program members, with different review vendors handling various service categories. Commercial members will see changes starting April 1, 2026 (medical oncology code replacements) and July 1, 2026 (addition of radiation oncology, advanced imaging, molecular genetic lab, and drug codes), while Medicare Advantage members will have new Part B Step Therapy and various code additions effective July 1, 2026.
Action Required
By April 1, 2026: Billing team must update prior authorization workflows for medical oncology code replacements reviewed by Carelon. By July 1, 2026: Update systems to require prior authorization for radiation oncology, advanced imaging, molecular genetic lab, medical oncology, and drug codes for commercial members, plus orthotic, MAPD, pharmacy, and miscellaneous codes for Medicare Advantage members. Always verify eligibility and benefits through Availity Essentials before rendering services. Services without required prior authorization may be denied and providers cannot bill members directly.