Beginning September 15, 2026, CareFirst BlueCross BlueShield Medicare Advantage plans (CareFirst BlueCross BlueShield Advantage Essential (PPO), Complete (PPO), Salute (PPO), and CareFirst BlueCross BlueShield Group Advantage (PPO)) plans will require prior authorization for physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services starting with the first visit. This change applies to these members receiving PT, OT or SLP services with dates of service on or after September 15, 2026. Providers should confirm member eligibility and benefits before rendering services and verify prior authorization requirements through the Prior Authorization Lookup Tool available within the CareFirst Provider Portal (CareFirst Direct). Here is the original email: view.sf.carefirst.com/?vawpToken=56ACP5T3X7EUXFBWU3F3ZZ2DHA.70249&utm_source=SFMC&utm_medium=email&utm_campaign=&utm_content=https%3a%2f%2fview.sf.carefirst.com%2f%3fvawpToken%3d%%tokenized_vawp_metadata%%&send_date=2026-07-14&email_name=Notification+of+PT,+OT,+SLP+Prior+Auth+Guidelines+for+Medicare+Advantage&env=7288579

Healthy Blue Adding a Second Weekly Payment Cycle Beginning June 16, 2026

Urgent Action Needed for Medicaid Compliance: Referring NPI billing requirements See attached text copied from the SC-APTA newsletter

CMS Proposes New Model That Could Highlight PTs’ Impact in Joint Replacement | APTA In its fiscal year 2027 Inpatient Prospective Payment System proposed rule, the Centers for Medicare & Medicaid proposed a nationwide expansion of its Comprehensive Care for Joint Replacement model. APTA will be submitting comments on the model, which the agency is calling “CJR-X”, by the June 9 deadline.

Professional fee schedule increase for September 1, 2026 Blue Cross Blue Shield of Massachusetts will update our commercial professional provider fee schedule effective for dates of service on or after September 1, 2026. Reimbursement for physical therapy services will increase in aggregate by 2%. Updates will be based on the Centers for Medicare & Medicaid Services’ (CMS’) 2026 adjustments to its Relative Value Units (RVUs)*.