Summary
Blue Cross and Blue Shield of Nebraska is implementing a new medical policy (III.274) for tissue transfer (flap) procedures effective May 1, 2026. Starting that date, preauthorization will be required for all tissue transfer flap procedures, and Interqual Criteria will be used for clinical review. The policy affects 24 specific CPT codes related to various flap procedures across multiple anatomical locations.
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What to do
Action · 4 steps
01Previously due May 1, 2026 (date passed; verify current applicability): Billing team must implement mandatory preauthorization requirements for all tissue transfer (flap) procedures using CPT codes 14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061, 14301, 14302, 14350, 15570, 15572, 15574, 15576, 15600, 15610, 15620, 15630, 15650, 15730, 15731, 15733, 15734, 15736, 15738, 15740, 15750, 15922, 15934, 15936, 15944, 15946, 15952, 15956, 49904, and 49905 for BCBSNE members.
02Update billing software and prior authorization workflows to require submission of clinical documentation supporting Interqual Criteria for all affected procedures.
03Train providers and front desk staff to obtain preauthorization before scheduling or performing these procedures.
04Claims submitted without required preauthorization will be subject to denial.
Codes mentioned
14000140011402014021140401404114060140611430114302143501557015572155741557615600156101562015630156501573015731157331573415736157381574015750159221593415936159441594615952159564990449905
Original notice
MPC January 2026
nebraskablue.com · Always check the source before changing claims.
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