CommercialPrior AuthHigh impact
MPC January 2026
Blue Cross Blue Shield of Nebraska·NE · Plastic Surgery, General Surgery, Dermatology +2 more·Medical Policy
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing a new medical policy requiring preauthorization for all tissue transfer (flap) procedures effective May 1, 2026. InterQual criteria will be used to evaluate these procedures, covering a comprehensive list of adjacent tissue transfers, pedicle flaps, and muscle/fasciocutaneous flaps.
Action Required
Before May 1, 2026: Billing team must update prior authorization workflows to require preauth for all tissue transfer/flap procedures (codes 14000-49905 series). Update billing software to flag these codes for prior auth requirements. Train staff on InterQual criteria submission process. Update encounter forms and EMR templates to remind providers of preauth requirement. Claims submitted without prior authorization will be denied.