CommercialPrior AuthHigh impact
AB2026-03-005 Medical policies
Capital Blue Cross·Oncology, Hematology, Endocrinology +3 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross has implemented new prior authorization requirements for specialty injectable medications and medical procedures. Key changes include PA requirements for new drug Itvisma (J3590), power wheelchair accessories (E0986), and radiofrequency ablation of thyroid tumors (60660, 60661).
Action Required
By April 1, 2026: Update billing system to require prior authorization for J3590 (Itvisma), E0986 (power wheelchair accessories), CPT 60660 and 60661 (thyroid tumor ablation). Remove code 77085 from vertebral fracture assessment billing. For specialty injectables, submit PA requests through Prime MPS GatewayPA Portal or call 800.424.1710 for urgent requests. Claims will be denied without proper authorization.