CommercialCoverageMedium impact
See Changes to Coverage for Breast Cancer Screening
BCBS Texas·TX · Radiology, Oncology, OB-GYN +3 more·General
Effective date
Jan 1, 2026
We identified it
Jan 12, 2026
Summary
Effective January 1, 2026, Blue Cross Blue Shield of Texas will cover breast cancer screening services (mammograms, MRIs, CT scans, contrast ultrasounds, biopsies, and pathology evaluations) as preventive care at no cost for members without a current breast cancer diagnosis. Members with existing breast cancer diagnoses will have cost-sharing for these services.
Action Required
Before January 1, 2026: Billing team must verify eligibility and benefits through Availity Essentials or preferred vendor prior to rendering breast cancer screening services to determine if no-cost preventive coverage applies. Update billing workflows to distinguish between screening services for members without breast cancer diagnosis (bill as preventive with no cost-sharing) versus diagnostic services for members with existing breast cancer diagnosis (bill with applicable cost-sharing). Train front desk staff to verify member's current breast cancer diagnosis status before scheduling.