CommercialPrior AuthHigh impact
MPC May 2025
Blue Cross Blue Shield of Nebraska·NE · Orthopedics, Oral & Maxillofacial Surgery, Pain Management·Medical Policy
Effective date
Aug 1, 2025
We identified it
Jun 19, 2026
Summary
BCBS Nebraska is implementing new preauthorization requirements for three orthopedic and surgical procedures effective August 2025. Total ankle replacement, orthognathic surgery, and nerve blocks will now require prior authorization using InterQual criteria, with genicular nerve blocks considered investigational.
Action Required
By August 1, 2025: Billing team must update system to require prior authorization for total ankle replacement (III.158), orthognathic surgery codes 21050, 21210, 21215, 21244, 21299, 21685 (III.243), and nerve block code 64454 (III.232) for BCBS Nebraska patients. Update encounter forms to alert providers. Access InterQual criteria through BCBS Nebraska Provider Procedures portal. Note that genicular nerve blocks are considered investigational and may be denied.