Prior Authorization requirements for bioengineered skin and soft tissue substitutes

Effective January 1, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will require prior authorization for all bioengineered skin and soft tissue substitute codes.

This update complies with Centers for Medicare & Medicaid Services (CMS) mandates, which requires the Plan to provide a sixty (60) day notice when adding new codes to prior authorization requirements.

This new policy will apply to all Blue Medicare HMO^℠, Blue Medicare PPO^℠, Healthy Blue + Medicare^℠ (HMO-POS D-SNP), Blue Medicare Rx^℠ members, and members of any third-party Medicare plans supported by Blue Cross NC through administrative or operational services.