CommercialPrior AuthHigh impact
MPC December 2025
Blue Cross Blue Shield of Nebraska·NE · Cardiology, Cardiothoracic Surgery·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska is updating two medical policies effective 4/1/2026: expanding cardiac catheter ablation policy to include all electrophysiology testing procedures, and broadening pacemaker policy to cover all pacemakers and defibrillators. Both policies now require preauthorization using InterQual criteria for extensive lists of cardiac procedure codes.
Action Required
By April 1, 2026: Billing team must update system to require prior authorization for all listed electrophysiology testing, cardiac catheter ablation, pacemaker, and defibrillator procedure codes. Update encounter forms and provider workflows to ensure preauthorization is obtained using InterQual criteria before scheduling these cardiac procedures. Claims submitted without proper preauthorization will be denied.