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CommercialPrior AuthHigh impact

MPC March 2022

Blue Cross Blue Shield of Nebraska·NE · Genetics, Oncology, Neurology +3 more·Medical Policy
Effective date
Jul 1, 2022
We identified it
Jun 24, 2026
Days to comply

Summary

Blue Cross Blue Shield of Nebraska updated multiple genetic testing and molecular analysis medical policies effective July 1, 2022, all requiring preauthorization. The updates include specific coverage criteria for genetic testing panels for aortopathies, hereditary cancer susceptibility, tumor molecular profiling, epilepsy, dermatological conditions, and skeletal dysplasia.

Action Required

Action needed
By July 1, 2022: Billing teams must implement preauthorization requirements for all listed genetic testing codes (81162, 81163, 81164, 81165, 81166, 81167, 81216, 81432, 81433, 0102U, 0129U, 0133U, 81292, 81294, 81295, 81297, 81298, 81300, 81317, 81319, 81437, 81438, 0211U, 81445, 81455, 81419, 81479, 81406, 81525, 81408) in billing system. Update encounter forms and provider workflows to verify patients meet specific clinical criteria outlined in each policy section before ordering tests. Claims submitted without proper preauthorization will be denied.

Affected Billing Codes

81162
81163
81164
81165
81166
81167
81216
81432
81433
81292
81294
81295
81297
81298
81300
81317
81319
81437
81438
81445
81455
81419
81479
81406
81525
81408