CommercialPrior AuthMedium impact
Important Updates to Policies and Handbook
Blue Cross Blue Shield of Vermont·VT·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Vermont is removing prior authorization requirements for two HCPCS codes (J0738 and J1961) effective August 1, 2026. These codes will change from requiring prior approval to being considered medically necessary without prior auth.
Action Required
By August 1, 2026: Billing team must update billing system to remove prior authorization requirements for HCPCS codes J0738 and J1961 for Blue Cross Blue Shield of Vermont patients. Update encounter forms and billing workflows to reflect that these codes no longer require prior approval. Note that pharmacy prior approval for these codes still goes through Optum Rx.