BCBS Nebraska Medical Policy Updates – October 2018

Click here to view the Blue Cross Blue Shield Nebraska Medical Policy Updates »

 October 2018 BCBS Nebraska Medical Policy Updates:

• 3-Dimensional And 4-Dimensional Fetal Ultrasound (Requires Preauthorization)
• Accelerated Irradiation Therapy, Brachytherapy, And Intraoperative Radiation Therapy (Iort) (Requires Preauthorization)
• Androgens (Preauthorization Required)
• Antigen Leukocyte Antibody Test
• Breast Cancer Prognosis Determination By Genetic Assay (Preauthorization Required)
• Cardiovascular Risk Panels (Requires Preauthorization)
• Chromosome Microarray Analysis For Developmental Delay, Autism, And/Or Congenital Anomalies  (Requires Preauthorization)
• Chromosome Microarray Analysis For The Evaluation Of Pregnancy Loss (Preauthorization Recommended)
• Cytochrome P450 Genotyping (Requires Preauthorization)
• Genetic Testing For Hereditary Hearing Loss (Requires Preauthorization)
• Genetic Testing For Heterozygous Familial Hypercholesterolemia (Requires Preauthorization)
• Genetic Testing For Macular Degeneration (Requires Preauthorization)
• Genetic Testing For Mental Health Conditions
• Genetic Testing For Mitochondrial Disorders (Requires Preauthorization)
• Heart Disease Reversal Programs (Ornish Program) (Requires Preauthorization)
• Hereditary Angioedema Treatment And Prophylaxis (Requires Preauthorization)
• Inpatient Intestinal Rehabilitation Therapy (No Preauthorization Required)
• Intensity Modulated Radiation Therapy (Imrt) (Requires Preauthorization)
• Intravenous Immune Globulin (Requires Preauthorization)
• Magnetic Resonance Neurography (Requires Preauthorization)
• Multianalyte Assay With Algorithmic Analysis For The Prediction Of Type 2 Diabetes (Requires Preauthorization)
• Multigene Expression Assay For Predicting Recurrence In Colon Cancer (Requires Preauthorization)
• Nocdurna (Desmopressin Acetate) Requires Prior Authorization
• Obrexza
• Oscillatory Devices For The Treatment Of Respiratory Disorders (The Vest Airway Clearance System) (Requires Preauthorization)
• Palb2, Chek2 And Atm For Breast Cancer And Genetic Risk (Preauthorization Required)
• Pcsk9 (Requires Preauthorization)
• Pharmacogenomic And Metabolic Markers For Patients Treated With Thiopurine (Preauthorization Required)
• Procedures Recommended For Medical Necessity Review (Requires Preauthorization)
• Radioembolization/Selective Internal Radiotherapy (Sirt) (Requires Preauthorization)
• Sequencing Based Tests To Determine Trisomy 13, 18, And 21 From Maternal Plasma (Preauthorization Recommended)
• Specialty Hospital Beds (Requires Preauthorization)
• Speech Generating Device (Requires Preauthorization)
• Transcranial Magnetic Stimulation As A Treatment Of Mental Illness And Other Brain Disorders (Requires Preauthorization)
• Ultraviolet Cabinet (Requires Preauthorization)
• Um Netresults  (Preauthorization Required)

Click here to view the Blue Cross Blue Shield Nebraska Medical Policy Updates »

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