CommercialPrior AuthMedium impact
MPC May 2025
Blue Cross Blue Shield of Nebraska·NE · Orthopedics, Oral & Maxillofacial Surgery, Pain Management·Medical Policy
Effective date
Aug 1, 2025
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing new preauthorization requirements for three medical policies effective August 2025, utilizing InterQual criteria for total ankle replacement and orthognathic surgery, while considering genicular nerve blocks investigational. Additional CPT codes are being added to the orthognathic surgery and nerve block policies.
Action Required
By August 1, 2025: Billing team must update system to require prior authorization for total ankle replacement and orthognathic surgery procedures using InterQual criteria. Add prior auth requirements for CPT codes 21050, 21210, 21215, 21244, 21299, 21685 for orthognathic surgery. By August 15, 2025: Flag CPT code 64454 (genicular nerve block) as investigational and requiring prior auth. Update encounter forms and train staff on new requirements to prevent claim denials.