All PlansCoverageMedium impact
Policy Criteria Change
Arkansas Blue Cross Blue Shield·AR · Urology, Orthopedics, Gastroenterology +2 more·Medical Policy
Effective date
Nov 15, 2026
We identified it
Aug 6, 2026
Summary
Arkansas Blue Cross has added non-coverage statements for six procedures/devices across four policies effective 11/15/2026: permanently implanted prostatic stent devices (ProVee, Zenflow) for BPH; cartilage implants (Cartiva, Agili-C) and implantable shock absorbers for knee osteoarthritis; percutaneous electrical nerve field stimulation for gut-brain disorders; maternal serum cell-free RNA tests for preeclampsia/preterm birth prediction; and restricted coverage for Kerecis Omega3 (Q4158) wound dressing. All are classified as not meeting evidence criteria or investigational and will be denied for most member contracts.
Action Required
By November 1, 2026: Billing team must update claims processing system to deny or require prior authorization review for: (1) CPT/HCPCS codes for prostatic stent insertion (BPH procedures); (2) cartilage implant codes and implantable shock absorber codes for knee osteoarthritis; (3) codes for percutaneous electrical nerve field stimulation for IBS/functional dyspepsia; (4) maternal serum testing codes (cell-free RNA tests) for preeclampsia and preterm birth prediction; (5) restrict Q4158 (Kerecis Omega3) to chronic diabetic lower-extremity ulcer treatment only per policy 2012009. Update denial reasons to reference non-coverage due to insufficient evidence. Notify providers in urology, orthopedics, gastroenterology, and OB-GYN of non-covered services and document member contract exclusions. Flag these services on encounter forms. Claims submitted without proper authorization or for non-covered indications will be denied; communicate expected denials to affected departments.