Blue Cross Blue Shield - Nebraska Coverage Criteria
- Blue Cross Blue Shield - Nebraska prior authorization
- All Blue Cross Blue Shield - Nebraska policy updates
Latest Blue Cross Blue Shield - Nebraska coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01HARLIKU (nitisinone) — Preauthorization RequiredPreauthorization policy governing medical necessity criteria for Harliku (nitisinone) to reduce urinary homogentisic acid (HGA) in patients with alkaptonuria; applies to coverage decisions made by Blue Cross Blue Shield - Nebraska.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Intracameral Implants (Requires Preauthorization)Policy governing preauthorization and medical necessity criteria for one-time intracameral drug-eluting implants (bimatoprost/Durysta and travoprost/iDose TR) to reduce intraocular pressure in patients with open-angle glaucoma or ocular hypertension.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2026-06-01MA Intracameral Implants (Preauthorization Required)Covers one-time intracameral bimatoprost (Durysta) and travoprost (iDose TR) implants for reducing intraocular pressure in adults with open-angle glaucoma or ocular hypertension and specifies preauthorization requirements and clinical criteria for medical necessity.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2026-06-01Pneumatic Compression Devices (Preauthorization Required)Defines preauthorization and coverage guidance for pneumatic compression devices and related HCPCS codes for Blue Cross Blue Shield of Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01REMOTE ELECTRICAL NEUROMODULATION FOR MIGRAINES (REQUIRES PREAUTHORIZATION)This policy defines medical necessity, coverage criteria, contraindications, and prior authorization requirements for use of remote electrical neuromodulation devices (e.g., Nerivio) for acute and preventive treatment of migraine for BCBS Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA General Approach to Laboratory Testing (Preauthorization Required)Defines general coverage criteria and preauthorization expectations for genetic/molecular and other laboratory tests not addressed elsewhere, including carrier, familial variant, single-gene/multigene panels, prenatal diagnosis, and other laboratory tests; applies to Blue Cross Blue Shield - Nebraska members and ordering providers subject to payer rules.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Lower Esophageal Myotomy for Treatment of Achalasia and Gastroparesis (Preauthorization Required)Policy governing preauthorization and medical necessity criteria for POEM to treat achalasia and the coverage stance for G-POEM for gastroparesis for BCBS Nebraska members and providers.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Oncology Testing: Hematologic Malignancy Molecular Diagnostics (Preauthorization Required)Governs coverage and medical necessity criteria for molecular diagnostic tests and panels used in evaluation, prognosis, and treatment selection for hematologic malignancies for Blue Cross Blue Shield - Nebraska members; applies to providers requesting preauthorization for these tests.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Reproductive Testing: Prenatal Diagnosis (Preauthorization Required)Defines medical necessity, preauthorization expectations, and coverage criteria for prenatal diagnostic genetic tests (CMA, exome, genome, targeted panels) via invasive sampling and for chromosomal microarray on products of conception; applies to Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Cardiovascular (Preauthorization Required)Policy M.88 governs preauthorization, medical necessity criteria, and coverage for genetic and specialty cardiovascular tests (multigene panels and related testing) for inherited and sporadic cardiomyopathies, arrhythmias, aneurysm syndromes, and related conditions; it applies to Blue Cross Blue Shield - Nebraska members and providers requesting testing.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Gastroenterology (Preauthorization Required)Medical policy governing preauthorization and medical necessity criteria for specialty laboratory and genetic tests used in non-malignant gastroenterologic conditions (e.g., hereditary hemochromatosis, pancreatitis, inflammatory bowel disease, and noninvasive liver disease). Affects providers requesting these tests for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Hematology (Preauthorization Required)Policy M.90 governs preauthorization and medical necessity criteria for genetic and specialty diagnostic tests for non-cancerous hematologic conditions for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Immunology and Rheumatology (Preauthorization Required)Governs preauthorization and medical necessity criteria for genetic, algorithmic, and biomarker tests used to evaluate autoimmune, immune deficiency, and rheumatologic conditions for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Multisystem Genetic ConditionsPolicy governing coverage criteria for broad and targeted genomic tests used to diagnose suspected multisystem genetic disorders for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Nephrology (Preauthorization Required)Defines preauthorization-required coverage criteria for genetic and specialty laboratory testing for known or suspected kidney disorders, including testing for potential living donors and APOL1 analysis; applies to Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Nutrition and Metabolism (Preauthorization Required)This policy governs preauthorization and medical necessity criteria for genetic and metabolic laboratory testing related to nutrition and metabolism for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Ophthalmology (Preauthorization Required)Policy governs preauthorization and medical necessity criteria for genetic and specialty diagnostic testing for inherited and other eye disorders for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Orthopedics (Preauthorization Required)Policy governs preauthorization and medical necessity criteria for genetic testing (single-gene and multigene panels) to establish or confirm diagnoses of osteogenesis imperfecta and other skeletal dysplasias/rare bone disorders for BCBSNE members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaAdministrative/Operational PolicyEff. 2026-05-01MA Specialty Testing: Respiratory (Preauthorization Required)Defines medical necessity and preauthorization requirements for genetic and other specialty diagnostic tests for respiratory disorders (e.g., alpha-1 antitrypsin deficiency, cystic fibrosis, and other genetic lung disorders) for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01MA Specialty Testing: Transplant (Preauthorization Required)Defines medical necessity and investigational criteria for donor-derived cell-free DNA and gene expression panel tests used in evaluation and monitoring of solid organ transplant recipients; applies to providers submitting preauthorization requests to Blue Cross Blue Shield - Nebraska.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01MA Cardiac Catheterization (Preauthorization Required)Preauthorization and medical necessity criteria for right, left, and combined cardiac catheterization procedures for BCBS Nebraska members; intended for providers requesting authorization.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01MA Electrophysiology and Cardiac Ablation (Preauthorization Required)Policy governing preauthorization, coverage criteria, and coding for electrophysiology (EP) studies and catheter ablation procedures for supraventricular and ventricular arrhythmias for Blue Cross Blue Shield - Nebraska members.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-26General exclusions from coverage (Chapter 16) — Coverage Criteria (Part 1)Describes categories of items and services excluded from Medicare payment and explains specific exclusion rules and examples; covers general exclusions and selected sections (§10, §30, §40, §50 and subsections).All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01MA Permanent Cardiac Pacemakers (Preauthorization Required)Defines medical necessity, coverage criteria, non-covered indications, and required preauthorization for implantation, replacement, and certain procedures for permanent single- and dual-chamber pacemakers and ICDs for Blue Cross Blue Shield - Nebraska.All Blue Cross Blue Shield - Nebraska updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01MA Prostate Rectal Spacers (Preauthorization Required)Policy governing preauthorization and medical necessity criteria for implantation of biodegradable perirectal (prostate-rectal) spacers to reduce rectal radiation dose in patients receiving radiation therapy for localized or locally advanced prostate cancer.All Blue Cross Blue Shield - Nebraska updates
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Tool Description
Search Blue Cross Blue Shield - Nebraska coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
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