CommercialPrior AuthHigh impact
Medical Policy Updates for August 2026
Blue Cross Blue Shield of Massachusetts·Neurology, Neurosurgery, Cardiology +6 more·Medical Policy
Effective date
Aug 1, 2026
We identified it
Jun 20, 2026
Summary
Major policy updates affecting multiple specialties effective August 1, 2026, including changes to neurology/neurosurgery, cardiology, orthopedics, and pharmacy policies. Key changes include revised criteria for laser thermal therapy, new investigational codes, and multiple drug policy updates with varying prior authorization requirements.
Action Required
By August 1, 2026: Billing teams must update systems to reflect that Laser Interstitial Thermal Therapy (Policy 948) no longer requires prior authorization for refractory epilepsy, malignant brain tumors, and radiation necrosis. Update encounter forms to note HCPCS code G0680 is now investigational (Policy 400). For pharmacy policies effective May 1, 2026: Ensure prior authorization processes are in place for newly added drugs including Rybrevant Faspro, Anzupgo, updated Mounjaro criteria, and multiple oncology and immune modulating drugs. Update step therapy requirements for Sephience, Brinsupri, and Harliku.