CommercialPrior AuthHigh impact
Medical Policy Updates for September 2026
Blue Cross Blue Shield of Massachusetts·Cardiology, Neurology, Pulmonology +3 more·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Multiple medical policy changes effective July 1, 2026 and September 1, 2026, including new prior authorization requirements for advanced cardiac imaging and sleep disorder management codes, expanded drug coverage criteria, and new EEG monitoring policies across multiple specialties.
Action Required
By July 1, 2026: Update billing system to require prior authorization through Carelon for all pharmacy policies listed (drugs 004, 041, 056, 063, 064, 099, 110, 310, 408). By September 1, 2026: Configure prior authorization requirements for CPT codes C9762, C9763 (cardiac imaging) and C8007, C8008, C8009, C8011, C8012, C8013 (sleep studies) through Carelon system. Update encounter forms to alert providers. Claims will be denied without proper prior authorization.