We are pausing implementation of changes to chiropractic billing guidelines that were announced August 1, 2025. The changes were made to the Alternative Care section of our Administrative Manual and were effective November 1, 2025.

• We are pausing implementation of this recent policy change. We will reprocess any claims for codes that have been denied due to this policy, starting November 1, 2025, and will no longer apply the policy until we have completed a full re-evaluation of the codes included in the policy.
• The initial policy change resulted from an extensive review that identified improper billing practices. The policy change aligned with our understanding of correct coding practices, and we provided 90 days’ notice of that update to providers in August.
• We appreciate the feedback on the policy now that it is live and will be pausing implementation to further engage stakeholders and evaluate that feedback. BridgeSpan will reassess the application of the policy to ensure members continue to receive the care they need and that we are not paying for codes and services that are outside a provider’s scope of practice.

11/14/2025

Effective January 1, 2026, we will expand coverage for preventive breast cancer screening services for our commercial members in alignment with updated federal guidance from the Health Resources and Services Administration (HRSA) and the Women's Preventive Services Initiative (WPSI). These organizations define what can be covered under Affordable Care Act (ACA) preventive care.

What’s changing
Under the new federal guidance, breast cancer screenings will include not only mammograms (currently covered) but also additional imaging and pathology evaluations. These services will be covered as preventive care with no member cost share, regardless of whether the member is enrolled in a health savings account (HSA) or non-HSA plan.

Expanded services include:

• Imaging: MRIs, ultrasounds and contrast mammography
• Pathology: Tissue biopsies and related pathology analysis

This broader coverage applies to members of all risk levels, ensuring that anyone who needs screening—regardless of personal or family history—can access comprehensive services without financial barriers.

Clarification on cancer diagnoses

A key distinction for 2026 is how screenings are handled for members with an active cancer diagnosis:

• These screenings are not considered preventive under ACA or Internal Revenue Services (IRS) guidelines
• Therefore, standard radiology cost shares will apply, even for non-HSA products

For HSA products:

• Deductibles will be waived only for members without an active cancer diagnosis
• Members with an active cancer diagnosis will have deductible applied, consistent with IRS Notice 2024-75

Preventive care flyer updates

Our preventive flyers have been updated to reflect the expanded breast cancer screening coverage.

10/27/2025