CommercialPrior AuthHigh impact
Medical Policy Updates for June 2026
Blue Cross Blue Shield of Massachusetts·MA · Radiology, Gastroenterology, Orthopedics +4 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Massachusetts issued comprehensive policy updates effective June 1, 2026, affecting multiple specialties with new prior authorization requirements, coverage changes, and updated genetic testing guidelines. Key changes include new prior auth requirements for brain imaging CPT 70472, spine surgery smoking cessation documentation requirements, and several procedures moving from investigational to medically necessary status.
Action Required
By June 1, 2026: Billing team must update systems to require prior authorization through Carelon for CPT 70472 (brain imaging) and radiation therapy codes 77436-77439. Update encounter forms and EMR templates to capture smoking cessation documentation for elective spine fusion surgeries (minimum 6 weeks cessation required). Remove prior auth blocks for POEM procedures and total body plethysmography as these no longer require authorization. Update coverage policies to reflect SADI-S and POEM moving to medically necessary status. Train staff on new genetic testing guidelines effective June 14, 2026.