Medical Policy Updates
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:
Effective December 1, 2026
New Medical Policies
Update: This policy was originally scheduled to take effect on November 1, 2026; however, the effective date has been postponed to December 1, 2026. Note: MUD Groups (MET prefix) will maintain the current workflow and submit authorization requests through the BCBSNE provider portal.
Medical Policy: III.277 Evolent Joint Surgery (Hip, Knee, Shoulder Surgeries) This applies to all fully insured groups as well as EHA (EHN prefix) and BCBSNE employees (NEQ prefix)
Effective Date:12/01/2026
Preauthorization Required: Yes
Policy:
Evolent will perform the preauthorizations.
Submission of the pre-service review.
- Call toll free 1-866-972-9642 from 7:00am - 7:00pm (CST) (8:00am-8:00pm EST).
- Visit the website www.RadMD.com
| Revision/Conversion Hip Arthroplasty | 27132, 27134, 27137, 27138 |
| Total Hip Arthroplasty/Resurfacing | 27130, S2118 |
| Femoroacetabular Impingement (FAI) Hip Surgery | 29914, 29915, 29916 |
| Hip Surgery - Other | 29860, 29861, 29862, 29863 |
| Revision Knee Arthroplasty | 27486, 27487 |
| Total Knee Arthroplasty (TKA) | 27447 |
| Partial-Unicompartmental Knee Arthroplasty (UKA) | 27446, 27438 |
| Knee Manipulation under Anesthesia (MUA) | 27570, 29884 |
| Knee Ligament Reconstruction/Repair | 27405, 27407, 27409, 27427, 27428, 27429, 29888, 29889 |
| Knee Meniscectomy/Meniscal Repair/Meniscal Transplant | 27332, 27333, 27403, 29868, 29880, 29881, 29882, 29883 |
| Knee Surgery – Other | 27412, 27415, 27416, 27418, 27420, 27422, 27424, 27425, 29866, 29867, 29870, 29873, 29874, 29875, 29876, 29877, 29879, 29885, 29886, 29887, G0289 |
| Revision Shoulder Arthroplasty | 23473, 23474 |
| Total/Reverse Shoulder Arthroplasty or Resurfacing | 23472 |
| Partial Shoulder Arthroplasty/Hemiarthroplasty | 23470 |
| Frozen Shoulder Repair/Adhesive Capsulitis |
29825 |
| Shoulder Labral Repair | 23450, 23455, 23460, 23462, 23465, 23466, 29806, 29807 |
| Shoulder Rotator Cuff Repair |
23410, 23412, 23420, 29827 |
| Shoulder Surgery - Other |
23120, 23125, 23130, 23405, 23415, 23430, 23700, 29805, 29819, 29820, 29821, 29822, 29823, 29824, 29825, +29826, 29828 |