CommercialPrior AuthMedium impact
MPC May 2024
Blue Cross Blue Shield of Nebraska·NE · PM&R (Physical Medicine & Rehab), Physical Therapy, Wound Care +2 more·Medical Policy
Effective date
Sep 1, 2024
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing new policies for pneumatic pumps and updating electrical stimulation policies, both requiring preauthorization starting September 1, 2024. These changes establish specific medical necessity criteria for lymphedema pumps and add restrictions on subcutaneous tibial nerve stimulation.
Action Required
By September 1, 2024: Billing team must update system to require prior authorization for all pneumatic pump claims and electrical stimulation procedures for Blue Cross Blue Shield of Nebraska patients. Update encounter forms and EMR templates to include documentation requirements for lymphedema pumps (diagnosis, unique characteristics for programmable pumps) and flag subcutaneous tibial nerve stimulation as investigational. Train providers on new medical necessity criteria to avoid claim denials.