CommercialPrior AuthMedium impact
Lung and Lobar Lung Transplant
Blue Cross & Blue Shield of Mississippi·MS · Pulmonology, Cardiothoracic Surgery, Critical Care·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross & Blue Shield of Mississippi updated their lung and lobar lung transplant policy (A.7.03.07), requiring prior authorization through case management for all transplant procedures and evaluations. The policy defines medical necessity criteria for lung transplantation in end-stage pulmonary disease and specifies that lung transplantation is investigational in all other situations.
Action Required
Immediately: Billing team must ensure prior authorization is obtained through Blue Cross & Blue Shield of Mississippi case management before scheduling any lung or lobar lung transplant procedures or evaluations. Update pre-authorization workflows to include this requirement. Claims will be denied without proper prior authorization.