CommercialPrior AuthHigh impact
Readmission Policy and Genetic Testing Updates
Blue Cross Blue Shield of Nebraska·NE · Genetics, Oncology, Cardiology +2 more·Medical Policy
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska updated multiple medical policies effective January 1, 2024, adding new preauthorization requirements for genetic testing, cardiac transplant rejection testing, and oncology molecular profiling, while establishing new coverage criteria for various genetic and molecular tests.
Action Required
Immediately: Billing team must update system to require preauthorization for all listed genetic testing codes (81271, 81274, 81222, 81223, 81442), cardiac transplant rejection testing (0087U), oncology molecular profiling (81542, 0047U, 81541, 0177U, 81309, 81445, 81455, and others), and exome sequencing codes (81415, 81416, 0214U, 0215U). Update encounter forms to alert providers that preauth is required. Review medical necessity criteria for each test type and ensure documentation meets new policy requirements. Claims without proper preauthorization will be denied.