Prior Authorization Changes for Some Commercial and Government Program Members

Aug. 31, 2026

We’re changing prior authorization requirements that may apply to some commercial and government program members.

Changes are based on updates from utilization management prior authorization assessment, Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System code changes from the Centers for Medicare & Medicaid Services.

For some services and members, prior authorization may be required through Blue Cross and Blue Shield of Montana. Utilization management and related services for members with Medicaid will be reviewed by Carelon Medical Benefits Management. Utilization management and related services for members with Medicare Advantage will be reviewed by BCBSMT and EviCore healthcare. Carelon Medical Benefits Management and Alacura Medical Transportation Management will review utilization management and related services for some commercial members.

 Review the upcoming changes by impacted members and effective dates below.

Commercial – Oct. 1, 2026:

  • Removal of behavioral health codes previously reviewed by BCBSMT

 Commercial – Jan. 1, 2027:

  • Removal of miscellaneous codes previously reviewed by Carelon
  • Addition of radiation oncology codes to be reviewed by Carelon

Medicare Advantage – Jan. 1, 2027:

  • Addition of miscellaneous codes to be reviewed by BCBSMT
  • Addition of Emerging Technology, Services & Procedures codes to be reviewed by BCBSMT

Medicare Advantage – Oct. 1, 2026:

  • Removal of oncology, immunology/specialty infusion and laboratory / molecular diagnostic codes previously reviewed by BCBSMT
  • Replacement of oncology codes to be reviewed by BCBSMT

See our revised list of codes. 

CPT copyright 2025 AMA. CPT is a registered trademark of the AMA.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. EviCore healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSMT. Carelon Medical Benefits Management is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT. 

Alacura Medical Transportation Management, LLC. is an independent company that has contracted with Blue Cross and Blue Shield of Montana to provide utilization management services for participants with coverage through BCBSMT.

BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.