Log In
Commercial Medical Policy Update for October 1, 2024
| Medical Guidelines | Reason for Update |
|---|---|
| Allergen Testing AHS – G2031 (PDF) | Allowed amount of allergen specific antibodies tested per year increased from 20 to 40, effective 10/15/24. Updated When Covered section criteria 2 to now read “When limited to allergens chosen for testing based on an individual’s history, physical examination, and environment, specific IgE in-vitro allergy testing (up to 40 allergen specific antibodies per year), reimbursement is allowed.” Medical Director review 9/2024. |
| Artificial Pancreas Device Systems (PDF) | Added the following statement to When Not Covered section, “The use of d-Nav technology for automated, intermittent glucose monitoring and insulin titration is considered investigational.” Updated Billing/Coding section to add 0740T and 0741T. |
| Cervical Cancer Screening AHS – G2002 (PDF) | Added 0502U to Billing/Coding section, effective 10/1/24. |
| Continuous Monitoring of Glucose in the Interstitial Fluid (PDF) | Removed the following statement from When Not Covered section, “The use of d-Nav technology for automated, intermittent glucose monitoring and insulin titration is considered investigational” as it is addressed in Artificial Pancreas Device Systems medical policy. Updated Billing/Coding section to removed 0740T and 0741T. Remove the following statement from Benefits Application section: “The DME supplier must meet eligibility and/or credentialing requirements as defined by the Plan to be eligible for reimbursement.” |
| Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation (PDF) | Added HCPCS codes A4543 and E0721 to Billing/Coding section, effective 10/1/2024. |
| Diagnosis of Vaginitis AHS – M2057 (PDF) | Added 0505U to Billing/Coding section, effective 10/1/2024. |
| Esophageal Pathology Testing AHS – M2171 (PDF) | Code 0506U added to Billing/Coding section, effective 10/1/24. |
| Gene Expression Profiling and Protein Biomarkers for Prostate Cancer AHS - M2166 (PDF) | Added PLA code 0495U to Billing/Coding section for 10/1/24 code update. |
| Immunopharmacologic Monitoring of Therapeutic Serum Antibodies AHS - G2105 (PDF) | Added 0514U and 0515U to Billing/Coding section, effective 10/1/2024. |
| Laboratory Procedures Medical Policy AHS - R2162 (PDF) | Codes 0482U, 0483U, 0484U, 0486U, 0510U, and 0511U added to the Billing/Coding section, effective 10/1/24. |
| Liquid Biopsy AHS - G2054 (PDF) | Added PLA codes: 0490U, 0491U, 0492U, 0496U, 0499U, 0500U, 0501U, 0507U to Billing/Coding section for 10/1/24 code update. |
| Microsatellite Instability and Tumor Mutational Burden Testing AHS - M2178 (PDF) | Added PLA codes 0487U, 0512U, 0513U to Billing/Coding section for 10/1/24 code update. |
| Molecular Analysis for Gliomas AHS - M2139 (PDF) | Added PLA code 0481U to Billing/Coding section for 10/1/24 code update. |
| Orthotics (PDF) | Added HCPCS codes L1653 and L1821 to Billing/Coding section, effective 10/01/24. |
| Oscillatory Devices for the Treatment of Respiratory Conditions (PDF) | Updated coverage criteria to include medically necessary criteria for individual that have a neuromuscular disorder affecting the ability to cough or clear respiratory secretions. Replaced “patient” with individuals throughout policy. Added A7021 and E0469 to Billing/Coding section, effective 10/1/2024. Medical Director review 8/2024. |
| Pathogen Panel Testing AHS – G2149 (PDF) | Codes 0480U and 0504U added to Billing/Coding section, effective 10/1/24. |
| Pharmacogenetics Testing AHS – M2021 (PDF) | Codes 0476U, 0477U, and 0516U added to Billing/Coding section, effective 10/1/24. |
| Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis (PDF) | Removed HCPCS codes E0650, E0651, E0652, E0655, E0656, E0657, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673 from the Billing/Coding Section and Added HCPCS code E0683 to the Billing/Coding Section effective 10/1/24. |
| Prescription Medication and Illicit Drug Testing in the Outpatient Setting AHS – T2015 (PDF) | Added 0517U, 0518U, 0519U, 0520U to Billing/Coding section, effective 10/1/24. |
| Proteogenomic Testing of Individuals with Cancer AHS - M2168 (PDF) | Added PLA code 0485U to Billing/Coding section for 10/1/24 code update. |
| Rhinoplasty (PDF) | Updated references. Medical Director Review 8/2024. Specialty Matched Consultant Advisory Panel 8/2024. |
| Skin and Soft Tissue Substitutes (PDF) | Updated When Covered section to update the link for the Humanitarian Device Exemption website. |
| Speech Generating Devices (PDF) | Code E2513 added to Billing/Coding section, effective 10/1/24. |
| Surgical Management of Transcatheter Heart Valves (PDF) | When Covered section updated to include coverage criteria for transcatheter mitral valve-in-valve replacement and the FDA definition of high risk for open surgery. Description, Policy Guidelines and References sections updated. Medical Director review 9/2024. |
| TENS (Transcutaneous Electrical Nerve Stimulator) (PDF) | Added A4544 and E0737 to Billing/Coding section, effective 10/1/2024. |
| Testing for Colorectal Cancer Management AHS - M2026 (PDF) | Added PLA code 0498U to Billing/Coding section for 10/1/24 code update. |
| Testing for Targeted Therapy of Non-Small-Cell Lung Cancer AHS - M2030 (PDF) | Added PLA code 0478U to Billing/Coding section for 10/1/24 code update. |
| Transplant Rejection Testing AHS – M2091 (PDF) | Codes 0493U, 0508U, and 0509U added to Billing/Coding section, effective 10/1/24. |
| Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hyperplasia (PDF) | Title changed from “Transurethral Water Vapor Thermal for Benign Prostatic Hyperplasia” to “Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hyperplasia”. Description section updated. Regulatory Status updated. Policy statement updated to include coverage criteria for Transurethral Water Jet Ablation. Policy Guidelines updated. Codes 0421T and C2596 added to Billing/Coding section. References updated. Medical Director review 6/2024. Policy noticed 07/31/2024 for Effective date 10/01/2024 |
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
Information in other languages: Español 中文 Tiếng Việt 한국어 Français العَرَبِيَّة Hmoob ру́сский Tagalog ગુજરાતી ភាសាខ្មែរ Deutsch हिन्दी ລາວ 日本語
© 2024 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.