CommercialPrior AuthHigh impact
MPC November 2022
Blue Cross Blue Shield of Nebraska·NE · Orthopedics, Oncology, Genetics +2 more·Medical Policy
Effective date
Jan 1, 2023
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska updated multiple medical policies effective January 1, 2023, adding new prior authorization requirements for computer-assisted surgical navigation procedures, genetic testing panels, and oncology algorithmic tests. Several orthopedic procedures including MAKO hip/knee replacement navigation are now classified as investigational.
Action Required
Before January 1, 2023: Billing team must update system to require prior authorization for all listed CPT codes including genetic testing panels (81435, 81436, 0101U), oncology algorithmic tests (81519, S3854, 81518), and stereotactic spinal procedures (61783). Update encounter forms to alert providers that computer-assisted surgical navigation for orthopedic procedures including MAKO hip/knee replacement is now investigational and may not be covered. Train staff on new criteria for breast cancer algorithmic testing coverage.