Medicare Advantage Medical Policy Updates
Medicare Advantage (MA) Part B Drug Prior Authorization List, Effective July 1, 2026
Blue Cross and Blue Shield of Nebraska MA is proud to work with our provider network to serve your patients, our members. We are updating several medical policies. Please review the changes and effective dates outlined here:
Revised Medical Policies
Medical Policy: M.16 MA Part B Utilization Management in the Absence of NCD or LCD
Effective Date: 07/01/2026
Preauthorization Required: Yes
Additional codes are being added that will require prior authorization
Codes: J0220, J0480, J0485, J0565, J0593, J0599, J1595, J1744, J2170, J2277, J2278, J2562, J2783, J2793, J2820, J2860, J2998, J3299, J3357, J7171, J7175, J7177, J7178, J7179, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7197, J7199, J7200, J7201, J7202, J7203, J7204, J7205, J7207, J7208, J7209, J7210, J7212, J7213, J7214, J7316, J7352, J9025, J9028, J9050, J9052, J9118, J9207, J9268, J9302, J9307, J9318, J9319, J9325, J9330, J9357
Medical Policy: M.17 MA Part B Utilization Management Review with NCD or LCD
Effective Date: 07/01/2026
Preauthorization Required: Yes
Codes: J7198, J7511
Medical Policy: M.18 Part B Step Therapy for Outpatient Medications
Effective Date: 07/01/2026
Preauthorization Required: Yes
Additional codes are being added that will require prior authorization
Codes: J1595, J3357