Medical Policy Update
Blue Cross and Blue Shield of Nebraska (BCBSNE) 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:
MPC May 2025
Updated Medical Policies
Medical Policy: III.158 Total Ankle Replacement
Effective Date: 08/01/2025
Preauthorization Required: Yes
Policy Statement:
Starting 08/01/2025 Interqual criteria will be utilized.
Medical Policy: III.243 Orthognathic Surgery
Effective Date: 08/01/2025
Preauthorization Required: Yes
Policy Statement:
Starting 08/01/2025 Interqual criteria will be utilized.
Additional codes being added to this policy: 21050, 21210, 21215, 21244, 21299, 21685
Access to Interqual criteria can be found at BCBSNE Provider Procedures.
Additional codes being added to this policy: 21050, 21210, 21215, 21244, 21299, 21685
Access to Interqual criteria can be found at BCBSNE Provider Procedures.
Medical Policy: III.232 Nerve Blocks and Ablation of Peripheral Nerves to Treat Pain
Effective Date: 08/15/2025
Preauthorization Required: Yes
Policy Statement:
Genicular nerve block is considered investigational for all indications.
Additional code added to policy: 64454
Additional code added to policy: 64454
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