All PlansCoverageMedium impact
Upcoming Policies effective June 2, 2025
Blue Cross and Blue Shield of Minnesota·Orthopedics, Gastroenterology, PM&R (Physical Medicine & Rehab) +4 more·Medical Policy
Effective date
Jun 2, 2025
We identified it
Jun 20, 2026
Summary
Three medical policies are being revised effective June 2, 2025: Manipulation Under Anesthesia (covering shoulder, knee, and spine procedures with specific criteria for medical necessity), Gastric Electrical Stimulation (for chronic gastroparesis treatment), and Wheelchairs/Mobility Assistive Equipment (with detailed criteria for manual wheelchairs, scooters, and power wheelchairs). Each policy establishes strict medical necessity criteria that must be documented for coverage approval.
Action Required
By June 2, 2025: Billing team must update prior authorization workflows and documentation requirements for manipulation under anesthesia procedures, gastric electrical stimulation devices, and wheelchair/mobility equipment claims. Providers must ensure all specified medical necessity criteria are documented in patient records before submitting claims. Update encounter forms and EMR templates to include required criteria checklists for these services. Claims not meeting the revised criteria will be denied as experimental/investigative or not medically necessary.