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Upcoming Policies effective July 1, 2026
Blue Cross and Blue Shield of Minnesota·Orthopedics, Neurosurgery, Pain Management·Medical Policy
Effective date
Jul 6, 2026
We identified it
Jun 20, 2026
Summary
Revised policy IV-87 for lumbar spinal fusion establishes comprehensive medical necessity criteria across 9 different scenarios including scoliosis, emergent conditions, and instability. All non-emergent cases require specific pain scores (VAS/NRS ≥7), functional impairment (ODI ≥25), conservative treatment failures, and tobacco cessation requirements.
Action Required
Before July 6, 2026: Billing and clinical teams must update prior authorization workflows to capture required documentation for lumbar fusion cases including VAS/NRS pain scores ≥7, Oswestry Disability Index scores ≥25, confirmatory imaging within 6 months, conservative treatment documentation, and tobacco cessation verification for minimum 6 weeks. Update EMR templates to include these specific criteria checklists. Claims not meeting these detailed medical necessity requirements will be denied.