Medicare AdvantagePrior AuthMedium impact
Prior Authorization Changes for Some Government Program Members
BCBS Montana·MT · Cardiology·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of Montana is changing prior authorization requirements for government program members with two phases: July 1, 2026 removes cardiology, lab, and miscellaneous codes from prior auth review, while August 1, 2026 adds new miscellaneous codes requiring prior authorization through BCBSMT.
Action Required
By June 30, 2026: Billing team must update prior authorization workflows - remove prior auth requirements for cardiology, lab, and miscellaneous codes previously reviewed by EviCore and BCBSMT effective July 1st. By July 31, 2026: Add prior authorization requirements for new miscellaneous codes to be reviewed by BCBSMT effective August 1st. Check the revised code list on the BCBSMT website and update billing system rules accordingly. Continue verifying eligibility through Availity Essentials before rendering services.