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CommercialPrior AuthMedium impact

MPC April 2023

Blue Cross Blue Shield of Nebraska·NE · Genetics, Oncology, Cardiology +3 more·Medical Policy
Effective date
Jul 1, 2023
We identified it
Jun 24, 2026
Days to comply

Summary

Blue Cross Blue Shield of Nebraska updated multiple genetic testing medical policies effective July 1, 2023, all requiring preauthorization. These policies cover hereditary cancer testing, oncology molecular analysis, circulating tumor DNA testing, inherited disorders, and various genetic panels with specific medical necessity criteria.

Action Required

Action needed
By July 1, 2023: Billing team must update systems to require preauthorization for all listed genetic testing codes (81201, 81203, 0211U, 81455, 0379U, 81479, 81210, 81275, 81311, 81403, 81243, 81244, 81405, 81406, 81408, 81407, 81439, 81370, 81375, 81376, 81377, 81382, 81383, 81256). Update encounter forms and EMR templates to include specific medical necessity criteria for each test type. Train providers on new documentation requirements. Claims without proper preauthorization will be denied.

Affected Billing Codes

81201
81203
81455
81479
81210
81275
81311
81403
81243
81244
81405
81406
81408
81407
81439
81370
81375
81376
81377
81382
81383
81256