CommercialPrior AuthHigh impact
AB2026-03-001 Updates and new information
Capital Blue Cross·Orthopedics, Cardiology, Neurosurgery +3 more·Provider News
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross implemented multiple changes including postponed electronic appeals submissions, new preauthorization requirements for several procedure codes effective May 1, 2026, expanded cardiology and musculoskeletal programs through TurningPoint, and new medical policies for CTA imaging, genetic counseling telehealth services, and various surgical procedures.
Action Required
By May 1, 2026: Billing team must update prior authorization system to require preauth for all listed procedure codes through TurningPoint for cardiology and musculoskeletal procedures, and through Evolent for brain/neck CTA studies. Update encounter forms and EMR alerts for affected procedures. Add CPT 96041 for genetic counseling telehealth services to billing system. Continue using mail/fax for appeals submissions until electronic portal issues are resolved - do not attempt electronic submissions through provider portal.