CommercialCoverageHigh impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Oncology, Hematology, Radiology +4 more·Medical Policy
Effective date
Apr 4, 2026
We identified it
Jun 19, 2026
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.
Action Required
Before April 4, 2026: Billing team must review and update prior authorization processes for PET/CT scans to align with new coverage criteria. Providers must document specific clinical scenarios (e.g., tumor staging, standard imaging limitations, rising tumor markers with negative standard imaging) that justify medical necessity. Update encounter forms and EMR templates to include required documentation elements for each cancer type. Train staff on new criteria to prevent claim denials.