Medical Policy Updates

Notification of Policy Revisions Effective July 21, 2020 (Posted May 12, 2020)

Medical Policy Revision
Balloon Ostial Dilation (Balloon Sinuplasty) "Notification" New policy developed. Balloon ostial dilation is considered medically necessary with criteria. Policy noticed 5/12/2020 for policy effective date 7/14/2020.
Bundling Guidelines "Notification" Added to Description section, item D: global surgery guidelines also apply to facility claims. Added Outpatient Code Editor (OCE) Edits to Related Policies section. Notification given 5/12/2020 for effective date 7/14/2020.
Esophageal Pathology Testing AHS – M2171 "Notification" New policy developed. BCBSNC will provide coverage for esophageal pathology testing when it is determined to be medically necessary because the medical criteria and guidelines are met. Medical Director review 4/2020. Policy noticed 5/12/2020 for effective date 7/21/2020.
Onychomycosis Testing AHS – M2172 "Notification" New policy developed. Reviewed by Avalon for 1st Quarter 2020 CAB. Medical Director review 4/2020. Policy noticed 5/12/2020 for effective date 7/21/2020.
Outpatient Code Editor (OCE) Edits "Notification" Updated description section to include global surgical package description. Added reference to Bundling Guidelines policy. Statement added to Policy Guidelines section: Evaluation and Management services during the global surgical period that are related to the surgical procedure are not eligible for separate reimbursement. Global surgery edits apply to professional and facility claims. Notification given 5/12/2020 for effective date 7/14/2020.