CommercialPrior AuthHigh impact
Knee Arthroplasty - West Central and North East Region
Blue Cross & Blue Shield of Mississippi·MS · Orthopedics·Medical Policy
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their knee arthroplasty policy for West Central and North East regions, requiring care coordination for ALL knee arthroplasty specialty services to determine medical necessity and appropriate place of treatment. The policy also specifies detailed hospital criteria for when knee replacement must be performed in hospital versus outpatient settings.
Action Required
Immediately: Billing team must ensure care coordination is obtained for ALL knee arthroplasty specialty services before scheduling procedures. Verify patient meets specific hospital criteria (ASA PS 4+, BMI 50+, or other listed conditions) before scheduling inpatient procedures. Update scheduling protocols to check BCBS Mississippi network provider status and coordinate with Company for place of treatment determination. Claims may be denied without proper care coordination.