All PlansCoverageMedium impact
Upcoming Policies effective June 1, 2026
Blue Cross and Blue Shield of Minnesota·Dermatology, Sleep Medicine, ENT (Ear, Nose & Throat) +3 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Three medical policies are being revised effective June 1, 2026: updated criteria for skin lesion removal, new hypoglossal nerve stimulation coverage for sleep apnea (including special provisions for Down syndrome patients), and revised cognitive rehabilitation coverage limited to traumatic brain injury, pediatric brain tumors, and stroke only.
Action Required
By May 1, 2026: Update prior authorization systems and clinical documentation templates for skin lesion removals to verify medical necessity criteria (malignancy concerns, symptoms like bleeding/pain, obstruction, or trauma-prone location). For sleep medicine: implement new hypoglossal nerve stimulation coverage criteria requiring Inspire device only, BMI ≤35, AHI 15-25 with documented CPAP failure. For cognitive rehabilitation: restrict coverage to traumatic brain injury, pediatric brain tumors, and stroke cases only - all other conditions including ADHD, autism, and adult brain tumors are now experimental. Train staff on new documentation requirements including sleep studies, drug-induced sleep endoscopy results, and conservative treatment summaries.