Medicare Advantage Medical Policy Updates

Effective January 1, 2027

Blue Cross and Blue Shield of Nebraska Medicare Advantage 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:

New Medical Policies

Medical Policy: M.66 Physical Therapy, Occupational Therapy, Speech Therapy

Effective Date: 01/01/2027
Preauthorization Required: Yes, however, prior authorization is not required for the first nine (9) visits. Authorization is required beginning with the 10th visit.

Codes: 92507, 92508, 92526, 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97037, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97530, 97535
Policy Statement:

Medicare Benefit Policy Manual
Chapter 15 – Covered Medical and Other Health Services

Sec 220 - Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance (Rev. 12425; Issued: 12-21-23: Effective: 01-01-24; Implementation: 01-02-24)

Sec 230 - Practice of Physical Therapy, Occupational Therapy, and Speech Language Pathology (Rev. 63, Issued: 12-29-06, Effective: 01-01-07, Implementation: on or before 01-29 07)

Revised Medical Policies

Medical Policy: M.12 MA Interventional Pain Management and Spinal Surgery

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 22586 22532, 22556, 22585, 22610, 22808, 22810, 22812, 22840, 22841, 22842, 22843, 22844, 22849, 22867, 22868, 22869, 22870, 27280, 62324, 62325, 62326, 62327, 62350, 62351, 62361, 62362, 63003, 63011, 63013, 63046, 63048, 63077, 63078, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63197, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63273, 63275, 63276, 63277, 63278, 63280, 63281, 63282, 63283, 63285, 63295, 63301, 63302, 63303, 63305, 63306, 63307, 64408, 64416, 64454, 64461, 64462, 64463, 64510, 64517, 64520, 64530, 64600, 64605, 64610, 64615, 64616, 64617, 64620, 64630, 64642, 64644, 64646, 64647, 64680, 64681

Medical Policy: M.63 MA Total Shoulder Arthroplasty

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 23470, 23800, 23802, 23921

Medical Policy: M.15 MA Procedures following NCD, LCD or MCG

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 0320U, 0494T, 0495T, 0496T, 0582T, 0584T, 0585T, 0586T, 0651T, 0664T, 0666T, 0667T, 0668T, 0669T, 0670T, 20974, 20975, 20979, 21172, 21175, 21179, 21180, 21230, 21248, 21249, 21256, 21260, 21261, 21263, 21267, 21268, 25922, 26530, 26531, 26535, 26536, 27125, 27278, 27299, 27412, 27415, 27437, 27438, 27440, 27441, 27442, 27443, 27446, 27700, 27703, 33928, 33929, 35301, 37215, 37216, 37217, 37218, 37246, 37247, 38243, 42950, 43647, 43648, 43843, 43881, 48160, 48550, 50080, 50081, 50250, 50541, 50542, 50547, 50590, 52648, 53440, 53445, 53850, 54400, 54401, 54405, 54406, 54408, 54410, 54411, 54415, 54416, 54417, 55860, 55862, 55865, 55875, 56810, 57106, 57111, 57156, 57288, 57425, 58280, 58285, 58661, 58674, 58720, 66761, 66821, 66982, 66983, 66984, 66985, 67221, 67909, 67971, 67973, 67974, 67975, 68700, 69320, 69805, 69806, 77407, 77412, 91110, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 99183, 99304, 99305, 99306, 99307, 99308, 99309, 99315, 99316, 99506, 99507, 99600, 99601, 99602, A0434, C1813, C2622, E0465, E0484, E0769, E0785, E0948, E1841, J7330

Medical Policy: M.13 MA Radiology

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 72240, 72255, 72265, 72270, 78099, 78199, 78299, 78300, 78300, 78305, 78306, 78315, 78399, 78499, 78600, 78605, 78630, 78725, 78730, 78799, 78800, 79005, 79101, 79200, 79300, 79403, 79440, C9791

Medical Policy: M.30 MA Permanent Cardiac Pacemakers

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 0572T, 0572T, 0573T, C1722, C1882, C1886, C1896, C1899, C1900

Medical Policy: M.89 MA General Approach to Laboratory Testing

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 0018M, 0315U, 0319U, 0323U, 0358U, 81190, 81554, 83006, 83080, 83951, 84433, S3844, S3849, S3866

Medical Policy: M.91 MA Specialty Testing: Neurology

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: S3846

Medical Policy: M.90 MA Specialty Testing: Hematology

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: S3850

Medical Policy: M.44 MA Reproductive Testing: Fertility

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 0254U

Medical Policy: M.17 MA Part B Utilization Management Review with NCD or LCD

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 38225, 38226, 38227, 38228, XW033C7, XW033G7, XW033H7, XW033J7, XW033K7, XW033L7, XW033M7, XW033N7, XW043C7, XW043G7, XW043H7, XW043J7, XW043K7, XW043L7, XW043M7, XW043N7, XW133J8, XW143J8

Medical Policy: M.55 MA Radiofrequency Ablation or Transarterial Therapy for the Liver

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 20982, 20983, 47381

Medical Policy: M.22 MA: Charged particle radiation, helium ion or proton, and stereotactic radiosurgery

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 63621

Medical Policy: M.3 Bioengineered Skin and Soft Tissue Substitutes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: A2022, A2023, A2024, A2025, A2026, A2027, A2028, C9361, C9727

Medical Policy: M.14 Amniotic Membrane and Fluid

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: Q4179 Q4222 Q4345

Medical Policy: M.67 MA Sinus Surgery

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: 30801

Medical Policy: M.16 MA Part B Utilization Management in the Absence of NCD or LCD

Effective Date: 01/01/2027
Preauthorization Required: Yes

Additional codes added to policy: J0172, J0256, J0257, J0567, J1442, J1447, J1460, J1560, J1571, J1640, J1750, J1756, J1809, J1930, J1932, J2354, J2502, J2916, J2941, J3145, J3472, J7172, J7173, J7174, J7175, J7179, J7211, J7313, J7330, J7402, J7504, J7516, J9015, J9019, J9032, J9041, J9046, J9048, J9049, J9051, J9054, J9058, J9059, J9153, J9155, J9176, J9202, J9203, J9229, J9262, J9289, J9294, J9295, J9296, J9297, J9305, J9314, J9322, J9323, J9324, J9395, Q0138, Q2050, Q5098, Q5099, Q5101,Q5110 Q5125, Q5135

Medicare Advantage Medical Policy Updates

New Medical Policies

Medical Policy: M.66 Physical Therapy, Occupational Therapy, Speech Therapy

Effective Date: 01/01/2027 Preauthorization Required: Yes, however, prior authorization is not required for the first nine (9) visits. Authorization is required beginning with the 10th visit.

Revised Medical Policies

Medical Policy: M.12 MA Interventional Pain Management and Spinal Surgery

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.63 MA Total Shoulder Arthroplasty

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.15 MA Procedures following NCD, LCD or MCG

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.13 MA Radiology

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.30 MA Permanent Cardiac Pacemakers

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.89 MA General Approach to Laboratory Testing

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.91 MA Specialty Testing: Neurology

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.90 MA Specialty Testing: Hematology

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.44 MA Reproductive Testing: Fertility

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.17 MA Part B Utilization Management Review with NCD or LCD

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.55 MA Radiofrequency Ablation or Transarterial Therapy for the Liver

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.22 MA: Charged particle radiation, helium ion or proton, and stereotactic radiosurgery

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.3 Bioengineered Skin and Soft Tissue Substitutes

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.14 Amniotic Membrane and Fluid

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.67 MA Sinus Surgery

Effective Date: 01/01/2027 Preauthorization Required: Yes

Medical Policy: M.16 MA Part B Utilization Management in the Absence of NCD or LCD

Effective Date: 01/01/2027 Preauthorization Required: Yes

Shop Plans

Member Support

Partner Resources

About Us

Effective Date: 01/01/2027
Preauthorization Required: Yes, however, prior authorization is not required for the first nine (9) visits. Authorization is required beginning with the 10th visit.

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes

Effective Date: 01/01/2027
Preauthorization Required: Yes