CommercialPrior AuthHigh impact
MPC August 2023
Blue Cross Blue Shield of Nebraska·NE · Cardiology, Ophthalmology, Sleep Medicine +2 more·Medical Policy
Effective date
Dec 1, 2023
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska updated multiple medical policies with new prior authorization requirements and coverage determinations. Key changes include new policies for dry eye treatments, cardiovascular risk panels, sleep apnea surgeries, and several new pharmacy policies requiring preauthorization.
Action Required
By December 1, 2023: Billing team must update system to require prior authorization for cardiovascular risk panels (codes 83698, 0052U), intensive pulse light therapy for dry eyes, maxillofacial surgery for sleep apnea, hyperbaric oxygen therapy, and new pharmacy products (Roctavian, Vyjuvek, Leqembi, Qalsody). Update encounter forms to alert providers of preauth requirements. Claims submitted without prior authorization will be denied.