CommercialPrior AuthHigh impact
MPC February 2024
Blue Cross Blue Shield of Nebraska·NE · Neurology, Pain Management, Dermatology +5 more·Medical Policy
Effective date
Jun 1, 2024
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing multiple policy changes effective June 1, 2024, including new preauthorization requirements for sympathetic nerve blocks, Botox/neurotoxin injections with FDA age restrictions, lymphedema treatments, and radiology procedures. Several policies are being retired including contact lens coverage for specific conditions and lumbar artificial disc procedures being moved to a different policy.
Action Required
By June 1, 2024: Billing team must update system to require preauthorization for sympathetic nerve blocks, Botox/neurotoxin injections (J0585, J0588, J0586), lymphedema treatments, and CT angiography abdomen (74175). Verify patient ages meet FDA requirements for Botox treatments before billing. Stop billing contact lens claims for bullous keratopathy, corneal ulcers, erosions, Stevens-Johnson syndrome, corneal transplants, Fuchs' dystrophy, and keratoconus as these will no longer be covered. For lumbar artificial disc codes (0164T, 0165T, 22857, 22860, 22862, 22865), follow Medical Policy III.187 criteria instead. Claims without proper preauthorization will be denied.