CommercialPrior AuthHigh impact
Medical Policy Updates for May 2026
Blue Cross Blue Shield of Massachusetts·MA · Psychiatry, Radiology, Endocrinology +6 more·Medical Policy
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Massachusetts announces multiple policy changes across behavioral health, pharmacy, and radiology specialties with various effective dates from February to May 2026. Key changes include new prior authorization requirements for numerous medications, step therapy additions for Medicare Part B drugs, and new MRI codes requiring Carelon authorization.
Action Required
Before March 15, 2026: Update billing system to require prior authorization for all listed pharmacy medications including new biosimilars and updated FDA indications. Before May 1, 2026: Configure Carelon prior authorization for MRI codes C8903, C8905, C8906, and C8908. Before April 1, 2026: Update behavioral health billing for new residential treatment criteria. Medicare providers must implement step therapy protocols for Cimerli, Ospomyv, and Xbryk immediately (effective February 1, 2026). Claims without proper authorization will be denied.