CommercialPrior AuthHigh impact
Genetic Testing Update
Blue Cross Blue Shield of Nebraska·NE · Oncology, Hematology, Transplant Surgery +3 more·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing comprehensive genetic and specialty testing policy updates effective July 1, 2025, requiring preauthorization for all covered testing including prostate cancer genomic tests, hematologic malignancy diagnostics, heart transplant gene panels, liver fibrosis tests, and cardiac genetic panels. All testing must meet specific medical necessity criteria to be considered covered rather than investigational.
Action Required
Before July 1, 2025: Billing team must update prior authorization requirements for all genetic and specialty testing services in Nebraska BCBS plans. Update billing system to flag prostate cancer genomic tests (Genomic Prostate Score, Prolaris, Decipher, ArteraAI), hematologic MRD testing, heart transplant gene panels, liver fibrosis tests, and cardiac genetic panels for mandatory preauth. Train providers on new medical necessity criteria for each test type. Create documentation checklists to verify patient eligibility before ordering tests. Claims submitted without proper preauthorization will be denied.