What insurance policy changes affect Pathology providers?

Pathology providers face policy updates from major payers including prior authorization requirements, billing code changes, reimbursement rate adjustments, and coverage criteria revisions. PolicyChanges.app tracks these updates daily across all major insurers.

How often do insurance policies change for Pathology?

Insurance payers publish policy changes on rolling schedules: some quarterly, some monthly, and some with immediate effect. Pathology practices typically see dozens of relevant changes per year across their contracted payers.

How do I get notified of new Pathology policy changes?

Sign up for a free PolicyChanges.app account and create a saved search filtered to Pathology. You will receive a daily digest whenever a new policy change matches your specialty filter.

Which payers post the most policy changes affecting Pathology?

Based on tracked changes, Pathology updates have come from payers including CareSource, Capital Blue Cross, Premera Blue Cross, Highmark, Blue Cross Blue Shield of Massachusetts.

Pathology Insurance Policy Changes

Keeping up with insurance policy changes that affect Pathology practices is a full-time job. This page aggregates the latest payer updates (prior authorization rule changes, reimbursement adjustments, billing code additions and removals, and coverage policy revisions) across all major insurers. Changes are identified and summarized daily so Pathology providers and their billing teams can act before deadlines pass.

High impact

Medical Policy and Coding Updates - August 2026

Premera Blue Cross·Effective Nov 15, 2026

This comprehensive August 2026 policy update from Carelon Medical Benefits Management affects genetic testing, somatic tumor testing, radiation oncology, and antipsychotic medications effective November 15, 2026. Major changes include expanded coverage for liquid biopsy testing in multiple cancer types, new non-medical necessity designations for specific tests, revised radiation oncology guidelines for non-malignant conditions, and updated criteria for hematologic malignancy testing. Billing teams must update prior authorization requirements, coverage determination logic, and clinical appropriateness screening across oncology, genetic testing, and radiation oncology services.

[Ohio] Billing Guidance

AB2026-08-001 Updates and new information

Medical Policy and Coding Updates - June 2026

HealthHelp Transition: Sign Up for Molecular Lab Prior Auth Training

Medical Policy Updates for October 2026

[Ohio] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility

[Georgia] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility

[New York] New reimbursement policy: Modifiers 90, 91, and 92: Laboratory Services — Professional and Facility

Policy Criteria Change-Material Amendment

[Georgia] Precertification/prior authorization list change notification

Medical Policy and Coding Updates - August 2026

[New York] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates

[Virginia] Carelon Medical Benefits Management Clinical Appropriateness Guidelines updates

MolDX: Molecular Testing for Solid Organ Allograft Rejection

Reimbursement Policy Updates

New genetic and molecular prior auth program requirements

Mutual News August 2026 Newsletter

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Virginia] Precertification/prior authorization list change notification

Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)

Comprehensive Genomic Profiling and Multigene Panel Testing for Solid Tumors - Medicare Advantage (Revised)

Medical and Clinical Policy Updates - Effective August 1, 2026

Investigational Gene Expression, Biomarker, and Multianalyte Testing

Circulating Tumor DNA and Circulating Tumor Cells for Management (Liquid Biopsy) of Solid Tumor Cancers

Correction to “Reimbursement Rate Updates for Certain CSHCN Procedure Codes Effective July 1, 2026”

Minimal Residual Disease Testing - Medicare Advantage (Revised)

Medical Policy Update July 1, 2026

Requirement to refer members to in-network providers

2026 CPT 2nd-quarter update: New codes

Genetic Testing Update Effective July 1, 2026

Updated CLIA Certifications and Claims Reprocessing for Certain Procedure Codes

Reimbursement Policy Updates

Reimbursement Policy Updates

Laboratory Payment Policies: June 1, 2026 updates

Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

[Georgia] Medical Policies and Clinical Utilization Management Guidelines update

Tumor Chemosensitivity Assays (CPB 0245, reviewed 2026-04-13)

Comprehensive Genomic Profiling and Multigene Panel Testing for Solid Tumors - Medicare Advantage (Revised)

[Georgia] Prior Authorization Requirement Update

Tumor Markers (CPB 0352, reviewed 2026-03-27)

Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers 2.02.51

Genetic and Coagulation Testing for Noncancer Blood Disorders - Medicare Advantage (Revised)

Polymerase Chain Reaction Testing: Selected Indications (CPB 0650, reviewed 2026-01-27)

2026 January Medical Policy Updates

MA06.034t, eviCore Lab Management

PT 55-26: Expanded Coverage of Biomarkers Including Expanded Carrier Screening

Medical Policy Update December 31, 2025

Tumor Chemoresistance Assays (CPB 0758, reviewed 2025-12-02)

25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

Oral and Esophageal Brush Biopsy (CPB 0686, reviewed 2025-10-15)