Log In
| Medical Guidelines | Reason for Update |
|---|---|
| BioZorb® | Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. |
| Brachytherapy, Intracavitary Balloon Catheter for Brain Cancer | Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. Updated description section. Reference added. |
| Specialty Matched Consultant Advisory Panel review 5/17/2023. Reference added. No change to policy statement. | |
| Added HCPCS code C1767 to Billing/Coding section. | |
Intensity Modulated Radiation Therapy for Tumors of the Central Nervous System | Specialty Matched Consultant Advisory Panel review 5/17/2023. Updated policy guidelines and reference added. No change to policy statement. |
Intensity Modulated Radiation Therapy (IMRT) for Sarcoma of the Extremities | Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. |
Intensity Modulated Radiation Therapy (IMRT) of Abdomen and Pelvis | Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. |
| Intensity Modulated Radiation Therapy (IMRT) of Head and Neck | Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. |
| Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. | |
Intensity-Modulated Radiation Therapy (IMRT) of the Prostate | Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. |
| Neurostimulation, Electrical | Added HCPCS code C1767 to Peripheral Subcutaneous Field Stimulation Billing/Coding section. |
| Specialty Matched Consultant Advisory Panel review 5/17/2023. Code C1767 added to Billing/Coding section. | |
| Related policies updated. References updated. Specialty Matched Consultant Advisory Panel review 4/2023. Medical Director review 4/2023. No change to policy statement. | |
Percutaneous Tibial Nerve Stimulation for Voiding Dysfunction | Routine review. Related Policies added. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 11/16/2022. |
Perirectal Spacer Use During Radiotherapy for Prostate Cancer | Specialty Matched Consultant Panel review 5/17/2023. No change to policy statement. Policy guidelines updated. Reference added. |
Radioembolization for Primary and Metastatic Tumors of the Liver | Specialty Matched Consultant Advisory Panel review 5/17/2023. No change to policy statement. |
| Radiosurgery, Stereotactic Approach | Specialty Matched Consultant Advisory Panel review 5/17/2023. Under “When covered” section: removed bullet (d) under Section B #2 which stated patient is not currently anticoagulated. No change to policy statement. |
Sacral Nerve Neuromodulation/Stimulation for Pelvic Floor Dysfunction | Added HCPCS code C1767 to the Billing/Coding section. |
| Added HCPCS code C1767 to the Billing/Coding section. | |
Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome | Added HCPCS codes C1767 to Billing/Coding section. |
Transurethral Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia | Policy review. References updated. Specialty Matched Consultant Advisory Panel review 11/16/2022. |
Vesicoureteral Reflux, Treatment with Periureteral Bulking Agents | Policy review. Specialty Matched Consultant Advisory Panel review 11/16/2022. |
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.