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Blue Cross and Blue Shield of MinnesotaAll Plans · Coverage · Medical Policy · MN · Orthopedics, Neurosurgery, Urology +2 moreMedium impact

Upcoming Policies effective November 2, 2026

Effective date
Nov 2, 2026
Identified
Sep 2, 2026

Summary

Revised medical policies for lumbar or thoracic spinal fusion (IV-87), sacral nerve neuromodulation (IV-83), bariatric surgery (IV-19) and cryoablation of solid tumors (IV-05) are effective November 2, 2026. The spinal fusion policy sets when fusion may be considered medically necessary for scoliosis, emergent conditions, instability, anticipated instability, recurrent disc herniation, spondylolisthesis, adjacent segment disease and repeat fusion at the same level. The other policies set criteria for temporary and permanent sacral nerve neuromodulation, initial and revision bariatric surgery, and cryoablation for specific solid tumors and bone metastases, and each marks other uses as experimental or investigative.

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What to do

Action · 6 steps
01Already effective November 2, 2026: Check the current applicability of these revised policies before billing these services.
02Documentation for lumbar or thoracic spinal fusion needs to show the listed criteria, including confirmatory imaging within the last 6 months, an Oswestry Disability Index of 25 or higher where required, a pain score of 7 or higher or daily severe, disabling, crippling, or incapacitating pain, and never-smoker status or abstinence from smoking, smokeless tobacco, nicotine products (not including nicotine replacement therapy) and marijuana vaping or smoking for at least 6 weeks before surgery.
03Axial (percutaneous) lumbar interbody fusion is addressed separately in policy IV-91.
04Sacral nerve neuromodulation documentation needs to show the listed diagnosis and the failure or intolerance of both behavioral and pharmacologic conservative therapy, and permanent implantation requires a trial stimulation period showing at least 50% improvement over at least 48 hours.
05Bariatric surgery documentation needs to show the listed BMI and comorbidity criteria, a mental health evaluation within 12 months before surgery, and at least 6 months of documented adherence to nutrition and behavior modification.
06Procedures the policies list as experimental or investigative are not medically necessary for the stated indications.

Original notice

Upcoming Policies effective November 2, 2026
bluecrossmn.widen.net · Always check the source before changing claims.
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Related changes

See all Blue Cross and Blue Shield of Minnesota changes →
Upcoming Policies effective July 1, 2026MediumEffective Jul 6, 2026 · Medical PolicyBrowse every Blue Cross and Blue Shield of Minnesota change in the policy list

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Blue Cross and Blue Shield of Minnesota policiesMN policy changesOrthopedicsNeurosurgeryUrologyBariatric SurgeryOncology

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