Summary
Arkansas Blue Cross updated coverage criteria for PET/CT scans across multiple cancer types (breast, colorectal, head/neck, lymphoma, melanoma, prostate, ovarian, gastric, bone cancers) and added new IMRT coverage for penile cancer. The changes specify when these imaging studies are medically necessary for diagnostic workup and disease management.
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What to do
Action · 4 steps
01Before April 4, 2026: Billing team must review and update prior authorization processes for PET/CT scans to align with new coverage criteria.
02Providers must document specific clinical scenarios (e.g., tumor staging, standard imaging limitations, rising tumor markers with negative standard imaging) that justify medical necessity.
03Update encounter forms and EMR templates to include required documentation elements for each cancer type.
04Train staff on new criteria to prevent claim denials.
Original notice
Policy Criteria Change
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Related changes
See all Arkansas Blue Cross Blue Shield changes →Policy Criteria ChangeHighEffective Nov 15, 2026 · Medical PolicyPolicy Criteria ChangeHighEffective Oct 28, 2026 · Medical PolicyPolicy Criteria ChangeMediumEffective Nov 15, 2026 · Medical PolicyPolicy Criteria ChangeHighEffective Oct 7, 2026 · Medical PolicyBrowse every Arkansas Blue Cross Blue Shield change in the policy list