Blue Cross Blue Shield of NebraskaCommercial · Prior Auth · Medical Policy · NE · Neurosurgery, Oncology, Dermatology +4 moreMedium impact
MPC November 2022
Effective date
Jan 1, 2023
Identified
Oct 10, 2026
Summary
This is a historical policy document (published October 2022, discovered October 2026) containing medical policy updates from Blue Cross and Blue Shield of Nebraska effective January 1, 2023. Changes include: adding CPT 61783 as investigational for spinal navigation procedures; updating breast cancer algorithmic testing criteria (Oncotype DX, Breast Cancer Index, and prognostic tests); clarifying cutaneous melanoma diagnostic testing coverage; refining hereditary colorectal cancer genetic testing criteria; adding serum creatine kinase requirement for Becker Muscular Dystrophy testing; updating Friedreich's Ataxia diagnostic criteria; and designating genetic algorithmic rheumatoid arthritis tests (PrismRA) as investigational. All changes required prior authorization and became effective over 3 years ago.
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01Already effective 2023-01-01 (3+ years elapsed): Verify whether the practice has implemented prior authorization requirements for affected codes in the billing system and confirm current applicability with Blue Cross and Blue Shield of Nebraska, as this is a historical policy document.
02If the practice services Nebraska patients under BCBS coverage, confirm: (1) CPT 61783 requires preauthorization for spinal navigation; (2) genetic testing codes 81519, 81518, 81520-81523, 81435, 81436, 0101U, 81284, 81286, 81599, and 81479 require preauthorization with specified medical necessity criteria; and (3) CPT 0090U (cutaneous melanoma testing) preauthorization status and investigational designations are current.
03Check with BCBS or review current policy documentation to determine if these requirements remain in effect or have been superseded.
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What is PolicyChanges
One workspace for payer rules, prior auth, coding and compliance
Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.