CommercialPrior AuthMedium impact
MPC May 2022
Blue Cross Blue Shield of Nebraska·NE · Urology, Neurosurgery, Orthopedics +4 more·Medical Policy
Effective date
Aug 1, 2022
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska has updated multiple medical policies effective August 1, 2022, introducing new prior authorization requirements for prostate rectal spacers, spinal cord tethering, and piriformis syndrome surgery, while also adding several new pharmacy policies with specific medical necessity criteria.
Action Required
By August 1, 2022: Billing team must update prior authorization requirements in billing system for prostate rectal spacers (SpaceOAR Hydrogel), spinal cord tethering procedures, piriformis syndrome surgery, blood ketone monitoring devices for epilepsy, and new pharmacy agents including Fyarro, Lutathera, Pluvicto, Enjaymo, and Pyrukynd. Update encounter forms to remind providers that preauthorization is required for all these services. Train staff on new medical necessity criteria for each policy. Claims submitted without required prior authorization will be denied.