Log In
Medical Policy Update for May 2, 2023
| Medical Guidelines | Reason for Update |
|---|---|
| Specialty Matched Consultant Advisory Panel review 11/16/2022. | |
Carrier Screening for Genetic Disease | References, Description, Related Policies and Policy Guidelines updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. |
| Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 8/24/2022. | |
| Policy review. Specialty Matched Consultant Advisory Panel review 10/19/2022. | |
| References added. Related policies and policy guidelines updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. | |
| Electrodiagnostic Studies | Policy review. Specialty Matched Consultant Advisory Panel review 10/19/2022. |
| Specialty Matched Consultant Advisory Panel review 11/16/2022. | |
| Description and policy guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. No change to policy statement. | |
| Description updated for clarity. References added. Updated When Covered section as follows: “If there has been a prior successful radiofrequency (RF) denervation (previously authorized by BCBSNC), then a minimum time of six (6) months has elapsed since prior RF denervation treatment (per side, per anatomical level of the spine). Prior success is defined as 50% or more pain relief documented in medical record. A repeat block is not necessary after 6 months or more have elapsed since prior RF denervation treatment, if symptoms and treatment are at the same location(s) or spinal level(s), and presentation is similar to that of initial or prior treatment.” Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director Review 4/2023. | |
General Approach to Evaluating the Utility of Genetic Panels | References updated. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. |
| Policy review. References added. Specialty Matched Consultant Advisory Panel review 11/16/2022. | |
Injection Therapy for Headache (Migraine and Other) and Non-Spine Management | Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 10/19/2022. |
| Interferential Stimulation | Policy update. Reference added. Specialty Matched Consultant Advisory Panel review 10/19/2022. |
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders | Policy guidelines updated. References added. Added the following statement to billing coding section “Use CPT code J3490 for Ketamine”. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. No Change to policy statement. |
Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease (GERD) | Policy review. Regulatory Status updated. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 11/16/2022. |
MRI-guided Laser Interstitial Thermal Therapy for Neurological Indications | Policy update. Specialty Matched Consultant Advisory Panel review 10/19/2022. |
Navigated Transcranial Magnetic Stimulation (nTMS) | Policy update. Specialty Matched Consultant Advisory Panel review 10/19/2022. |
Neural Therapy | Related policies updated. References added. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. No change to policy statement. |
| References added. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. No change to policy statement. | |
| Specialty Matched Consultant Advisory Panel review 11/16/2022. | |
| Policy review. Specialty Matched Consultant Advisory Panel review 11/16/2022. | |
Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis | Policy review. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 11/16/2022. |
| Description updated. References added. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. No change to policy statement. | |
| Policy update. Specialty Matched Consultant Advisory Panel review 10/19/2022. | |
| Policy review. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 10/19/2022. | |
| Policy review. Specialty Matched Consultant Advisory Panel review 11/16/2022. | |
| Policy guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. No change to policy statement. | |
| Policy review. Specialty Matched Consultant Advisory Panel review 10/19/2022. | |
| Policy review. Specialty Matched Consultant Advisory Panel review 11/16/2022. | |
| Policy review. Reference added. NCCN guideline updated. Specialty Matched Consultant Advisory Panel review 11/16/2022. Description section updated. When Covered statement updated to include criteria for whole gland cryoablation for initial treatment. When Covered statement for whole gland high intensity focused ultrasound unchanged. Policy Guidelines updated. Medical Director review. |
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.