CommercialPrior AuthMedium impact
09.00.46at, High-Technology Radiology Services (Independence)
Independence Blue Cross·Radiology, Cardiology·Medical Policy
Effective date
Nov 15, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated its High-Technology Radiology Services policy (version 09.00.46ax) to add CPT codes 95965 and 95966 to the list of services subject to Carelon Medical Benefits Management utilization review. Effective 11/15/2025, these codes now require medical necessity review per Carelon's Advanced Imaging Clinical Appropriateness Guidelines for Radiology before authorization.
Action Required
By 11/15/2025: Billing team must update systems to route CPT codes 95965 and 95966 to Carelon Medical Benefits Management for prior authorization review when billing Independence Blue Cross commercial members. Verify that EMR/billing software reflects these codes as requiring Carelon pre-authorization per their Advanced Imaging Clinical Appropriateness Guidelines for Radiology. Update provider encounter forms or templates to alert providers that these services require pre-auth. Failure to obtain authorization from Carelon before service delivery will result in claim denials for non-emergency, outpatient services.