CommercialDocumentationHigh impact
Payment Policy Material Amendment
Arkansas Blue Cross Blue Shield·AR · Plastic Surgery, General Surgery, OB-GYN·Payment Policy
Effective date
Jul 15, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross and Blue Shield has published a new payment policy for mastectomy and breast reconstruction procedures under Arkansas Act 561, effective July 15, 2026. The policy requires manual review for specific surgical procedures and mandates reimbursement at 100% or greater of acquisition cost for required supplies, with providers needing to submit itemized invoices for mesh and nerve graft materials.
Action Required
Before July 15, 2026: Billing team must update systems to flag all listed mastectomy and breast reconstruction CPT codes for manual review. Create workflow to collect and submit itemized invoices for all artificial/biological mesh and nerve graft supplies with claims. Update documentation requirements to include clinical justification for reconstruction techniques and verification that services are furnished in connection with covered mastectomy under Act 561. Train providers on new documentation requirements as claims without proper invoices and justification may face delays or denials.