| Medical Guidelines | Reason for Update |
|---|---|
| Balloon Dilation of the Eustachian Tube | Description updated. When Covered section updated as follows: ETD systems must be present for three months instead of twelve. Removed laryngopharyngeal reflux as a potential co-occurring condition in criterion 3. Criterion 1d updated from “Symptoms are continuous rather than episodic (e.g., symptoms occur only in response to barochallenge such as pressure changes while flying)” to “Symptoms are continuous or recurrent in response to barochallenges (e.g., flying, scuba diving, or other pressure changes), provided they significantly affect quality of life or functional health status.” Policy Guidelines and References also updated. Medical Director review 2/2026. Specialty Matched Consultant Advisory Panel review 2/2026. |
| General Genetic Testing, Somatic Disorders AHS - M2146 | Codes 0620U and 0621U added to Billing/Coding section, effective 4/1/26. |
| Genetic Markers for Assessing Risk of Cardiovascular Disease AHS - M2180 | Codes 0617U added to Billing/Coding section, effective 4/1/26. |
| Genetic Testing for Familial Alzheimer’s Disease AHS – M2038 | Added the following CPT codes to the Billing/Coding section: 0616U, effective 4/1/2026. |
| Genome and Exome Sequencing AHS – M2032 | Code 0628U added to Billing/Coding section, effective 4/1/26. |
| Implantable Bone Conduction Hearing Aids | Description and Regulatory Status sections updated. Clarified age requirements for Sentio and Bonebridge devices based on FDA approval in the “When Covered” section. Added additional bone conduction hearing aids to the applicable audiologic criteria per the FDA approvals in the into the “When Covered” section. Reorganized the “When Covered” section to provide greater clarity. No change to policy intent. References updated. Specialty Matched Consultant Review 2/2026. Medical Director review 2/2026. |
| Intravenous Antibiotic Therapy for Lyme Disease | References updated. One Related Policy added. Medical Director review 2/2026. Specialty Matched Consultant Advisory Panel review 2/2026. |
| Lyme Disease Testing AHS – G2143 | Added the following CPT codes to the Billing/Coding section:0615U, effective 4/1/2026. |
| Microprocessor-Controlled Prostheses for the Lower Limb | HCPCS code L2221 added to Billing/Coding section effective 4/1/26. |
| Molecular Diagnostics for Breast Cancer Prognosis AHS - M2020 | Added CPT code 0630U to Billing/Coding section for effective date 4/1/26. |
| Myoelectric Prosthetic Components for the Upper Limb | HCPCS codes A8005 and A8006 added to the Billing/Coding section effective 4/1/26. |
| Skin and Soft Tissue Substitutes | Updated Billing/Coding section to add A2040, A2041, A2042, A2043, A2044, A2045, G0681, G0682, G0683, G0684, Q4418, Q4419, Q4421, Q4422, Q4423, Q4424, Q4425, Q4426, Q4427, Q4428, Q4429, Q4435, Q4436, Q4437, Q4438, Q4439, Q4440. |
| Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome | Updated Billing/Coding section to add C8007, C8008, C8009, C8011, C8012, C8013. |
| Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders | Updated Regulatory Status. Updated Related policies. Updated When Covered section #2.a to read “Failure of 2 trials of psychopharmacologic agents to treat major depressive disorder including 2 different agent classes during the current depressive episode for adults (18 and up) and for adolescents (15-17); or” and #2.b to read “Inability to tolerate a therapeutic dose of medications as evidenced by 2 trials of psychopharmacologic agents with distinct side effects.” Updated When Covered #3 for clarity. Updated When Covered for Repeat rTMS and Initial/Repeat therapy to read “At least 6 months has passed since the end of the initial course of treatment.” Updated When Not Covered to add “Repetitive TMS of the brain is considered investigational as a treatment of active substance use or primary substance use disorder within the last 90 days.” Updated references. Medical Director review 1/2026. Specialty Matched Consultant Advisory Panel review 1/2026. Notification give 1/21/2026 for effective date 4/1/2026. |
| Whole Body Computed Tomography Scan as a Screening Test | Policy titled “Whole Body Computed Tomography Scan as a Screening Test” reinstated. Policy statement updated: “Whole body computed tomography scan as a screening test is considered investigational. BCBSNC does not provide coverage for investigational services or procedures.” Description, Policy Guidelines and References updated. Related policies section added. Code 76497 added to Billing/Coding section. Specialty Matched Consultant Advisory Panel review 11/2025. Medical Director review 11/2025. Notification given 1/21/26 for effective date 4/1/26. |
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