Clinical/Medical Policy policy updates
Track new and updated Clinical/Medical Policy policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Recommended Clinical Review Procedure Code List (Imaging) | Blue Cross Blue Shield - Texas | Clinical | Radiology/Diagnostic Imaging | Modified | Jan 1, 2026 |
| Hepatitis Testing | Blue Cross Blue Shield - Texas | Clinical | Laboratory/Pathology | Modified | Nov 7, 2025 |
| 2025 Drug List (Pharmacy Formulary) — Coverage Criteria | Blue Cross Blue Shield - Texas | Clinical | Pharmacy & Specialty Drugs | Modified | Oct 1, 2025 |
| 2025 Drug List (Pharmacy Benefit) — Formulary and Coverage Criteria | Blue Cross Blue Shield - Texas | Clinical | Pharmacy & Specialty Drugs | Modified | Oct 1, 2025 |
| 2025 Drug List (Pharmacy Benefit) — Formulary and Utilization Management | Blue Cross Blue Shield - Texas | Clinical | Pharmacy & Specialty Drugs | Modified | Oct 1, 2025 |
| Cervical Cancer Screening | Blue Cross Blue Shield - Texas | Clinical | Obstetrics/Gynecology | Modified | Sep 26, 2025 |
| Prostate Biopsy Specimen Analysis | Blue Cross Blue Shield - Texas | Clinical | Urology | Modified | Sep 26, 2025 |
| Diagnostic Testing of Influenza | Blue Cross Blue Shield - Texas | Clinical | Laboratory/Pathology | Modified | Sep 25, 2025 |
| Allergen Testing | Blue Cross Blue Shield - Texas | Clinical | Allergy/Clinical Immunology | Modified | Sep 5, 2025 |
| Pathogen Panel Testing | Blue Cross Blue Shield - Texas | Clinical | Laboratory/Pathology | Modified | Aug 1, 2025 |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.