| Medical Policy | Revision |
|---|---|
| Diagnosis of Vaginitis AHS - M2057 | Reviewed by Avalon 4th Quarter 2025 CAB. Description, Policy Guidelines, and Reference sections updated. Updates made to all coverage criteria for clarity and consistency. Updated When Covered section to remove NAAT or PCR based identification of Trichomonas and screening for Trichomonas for individuals with risk factors as it is now addressed in Diagnostic Testing of Sexually Transmitted Infections AHS – G2157. Added limit of “no more than one test every seven days” for NAAT panel testing designed to detect more than on type of vaginitis for individuals with signs and symptoms. Added Note 1. Updated When Not Covered section to add: “Reimbursement is not allowed for NAAT testing for Candida (e.g., quantitative NAAT testing) for all other situations not described above.” Updated Billing/Coding section to add 0068U and remove 87661. Medical Director review 10/2025. Notification given 12/10/2025 for effective date 2/11/2026. |
| Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease AHS - G2110 | Reviewed by Avalon 4th Quarter 2025 CAB. Description, Policy Guidelines and References updated. Removed codes 88341 and 88342 from the Billing/Coding section. Coverage criteria under When Covered and Not Covered are now numbered. Updates to When Covered section: criteria 1 updated and now reads “In order to determine therapy, the use of multianalyte assay with algorithmic analysis for noninvasive assessment of hepatic fibrosis and necroinflammatory activity (e.g., FibroTest®, also known as FibroSURE®, ELF™(ELFTM)) in an individual with chronic liver disease secondary to metabolic dysfunction associated steatotic liver disease (MASLD) (including metabolic dysfunction-associated steatohepatitis [MASH]), or alcoholic hepatitis, or to rule out compensated advanced chronic liver disease (cACLD) for individuals with an elevated liver stiffness measurement, is considered medically necessary once every six months.”, new coverage criteria 2 added and reads “For individuals with a chronic hepatitis B (HBV) or chronic hepatitis C (HCV) viral infection, FibroSURE® (i.e., HBV FibroSURE®, HCV FibroSURE®), ELF™(ELFTM), or FibroTest® testing once every six months is considered medically necessary.” Updates to Not Covered section: ELF™(ELFTM) testing added to criteria 1 and 2. Criteria 4 edited and now reads: “Except when included as a component of one of the multianalyte assays described above, the use of the following serum biomarkers in the diagnosis, prognosis, or monitoring of chronic liver disease is not covered: ….” Medical Director review 10/2025. Notification given 12/10/2025 for effective date 2/11/2026. |
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
© 2025 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.