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Blue Cross Blue Shield of NebraskaAll Plans · Prior Auth · Medical Policy · NE · Neurology, Psychiatry, Pediatrics +6 moreMedium impact

MPC March 2026

Effective date
Jul 1, 2026
Identified
Oct 10, 2026

Summary

Blue Cross and Blue Shield of Nebraska is implementing five new medical policies effective July 1, 2026, affecting diagnostic and therapeutic procedures including quantitative EEG for ADHD/autism/cognitive impairment (investigational), compression pumps for lymphedema and venous ulcers (with new prior authorization requirements), postsurgical compression devices for VTE prophylaxis (investigational except in specific post-orthopedic and high-risk scenarios), ophthalmologic imaging for glaucoma (certain modalities covered, others investigational), and breast imaging (scintimammography investigational; sentinel node lymphoscintigraphy covered). Prior authorization is newly required for compression pumps, postsurgical VTE compression devices, and ophthalmologic imaging.

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What to do

Action · 6 steps
01Previously due July 1, 2026 (date passed; verify current applicability).
02Billing team must enable prior authorization requirements in the billing system for compression pump procedures (lymphedema and venous ulcer treatment), postsurgical limb compression devices for VTE prophylaxis, and ophthalmologic imaging techniques (CPT 92133, 0198T, 92132).
03Front desk and authorization staff should screen for medical necessity documentation before claim submission, including evidence that lymphedema has failed conservative measures, that patients have contraindications to pharmacologic VTE prophylaxis, or that ophthalmologic imaging is clinically indicated.
04Providers should be notified that quantitative EEG assessment (theta/beta ratio) and scintimammography/breast-specific gamma imaging are considered investigational and likely non-covered; claims for these services may be denied.
05Verify that postsurgical compression device authorization is limited to ≤30 days post-surgery per policy guidelines.
06Review clinical input appendix (referenced but not provided in this notice) for specific guidance on lymphedema treatment sites beyond limbs.

Codes mentioned

9213392132

Original notice

MPC March 2026
nebraskablue.com · Always check the source before changing claims.
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Related changes

See all Blue Cross Blue Shield of Nebraska changes →
MPC March 2026HighEffective Jul 1, 2026 · Medical PolicyMPC March 2022MediumNo effective date · Medical PolicyMPC March 2022MediumEffective Jul 1, 2022 · Medical PolicyMPC March 2022HighEffective Jun 1, 2022 · Medical PolicyBrowse every Blue Cross Blue Shield of Nebraska change in the policy list

Related policy hubs

Blue Cross Blue Shield of Nebraska policiesNE policy changesNeurologyPsychiatryPediatricsWound CareVascular SurgeryOrthopedicsOncologyOphthalmologyRadiologyCode 92133Code 92132

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