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Blue Cross NC Home Providers Policies, guidelines and codes Commercial Medical Policy Update July 15, 2026 Commercial Medical Policy Update July 15, 2026

 

Medical Guidelines	Reason for Update
Ambulatory Event Monitors and Outpatient Cardiac Telemetry	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Amniotic Membrane and Amniotic Fluid Injections for Ophthalmic Indications	References updated. Related policies updated and removed Meniscal Allograft and Other Meniscus Implants. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Aqueous Shunts and Devices for Glaucoma	References updated. Minor grammar edits, the word Patients replaced with Individuals. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2025.
Artificial Pancreas Device Systems	Description and Policy Guidelines updated. Added positive coverage criteria for the use of an automated insulin delivery system with a low glucose suspend feature or artificial pancreas device system designated as hybrid closed-loop insulin delivery system (with low glucose suspend and suspend before low features) for individuals with type 2 diabetes. References added. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Cardiac (Heart) Transplantation	Description, Policy Guidelines and References updated. When Covered section edited for clarity, no change to policy statement. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Carotid Artery Angioplasty/Stenting (CAS)	Description, Policy Guidelines and References updated. When Covered statement edited for clarity and now reads “Carotid angioplasty with the placement of a Food and Drug Administration (FDA) approved carotid stent with an FDA-approved or cleared embolic protection device may be considered medically necessary in individuals with….”, no change to policy statement. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Computer Assisted Surgical Navigational Orthopedic Procedures	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Computerized Corneal Topography	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Congenital Heart Defect, Repair Devices	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Continuous Monitoring of Glucose in the Interstitial Fluid	Description, policy guidelines, and references updated. Removing code 99091 from Billing/Coding section. Please refer to the Member's Benefit Booklet for availability of benefits. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No change to policy statement.
Corneal Collagen Cross-linking	References updated. Regulatory section updated. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Electrical Bone Growth Stimulation	References updated. Regulatory status updated. Lumber Spine Procedures removed from related policies. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Epiretinal Radiation Therapy for Age-Related Macular Degeneration	References updated. Policy guidelines updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No change to coverage intent.
Extracorporeal Shock Wave Treatment for Musculoskeletal Conditions and Wound Healing	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome	References updated. Policy Guidelines updated with result from current trials. Definition of Thermal pulsation moved from Policy guidelines and placed in Description of Procedure section. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.  No change to policy intent.
Fundus Photography	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. Policy Archived.
Glaucoma, Evaluation by Ophthalmologic Techniques	References updated. Inserted chart with Selected Ocular Imaging Devices Cleared by the U.S. Food and Drug Administration. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No change to policy statement.
Implantable Cardioverter Defibrillator	Description, Policy Guidelines and References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Insulin Therapy, Chronic Intermittent Intravenous (CIIIT)	References added. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No changes to policy statement or intent.
Islet Cell Transplantation	Description and references updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No changes to policy statement or intent.
Keratoprosthesis	References updated. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Leadless Cardiac Pacemakers	Description section edited for clarity. Updated Policy Guidelines and References. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Medically Monitored Inpatient Withdrawal Management (Non-Hospital Medical Detox)	Replaced “patient” with “individual” throughout the policy. Specialty Matched Consultant Advisory Panel Review 6/2026. References added. No change to policy statement. Medical Director review 6/2026. Archive policy.
Microprocessor-Controlled Prostheses for the Lower Limb	When not covered section updated to include “Myoelectric controlled lower-limb orthoses are considered investigational.” Policy noticed 5/6/26 for effective date 7/15/26. Medical Director review 4/2026.
Myoelectric Prosthetic Components for the Upper Limb	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Optical Coherence Tomography (OCT) Anterior Segment of the Eye	References updated. Minor grammar changes. Specialty Matched Consultant Advisor Panel review 6/2026. Medical Director review 6/2026.
Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention	Description, Policy Guidelines and References updated. When Covered section edited to replace “patients” with “individuals”, no change to policy statement. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Quantitative Electroencephalography	Updated file name. Policy guidelines updated. References added. Specialty Matched Consultant Advisory Panel review 6/2024. Medical Director review 6/2024. No change to policy statement.
Refractive Surgery	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. Policy Archived.
Rehabilitative Therapies	Codes 98925, 98926, 98927, 98928, and 98929 removed from the Billing/Coding section.
Retinal Prosthesis	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Sensory Integration Therapy and Auditory Integration Therapy	Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No change to policy statement. Policy archived.
Surgery for Groin Pain in Athletes	References updated. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Surgical Ventricular Restoration	Description and References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Transcatheter Closure of Ventricular Septal Defects	References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Transcatheter Heart Valve Procedures	Policy retitled to Transcatheter Heart Valve Procedures. Policy statement updated: “Transcatheter Heart Valve Procedures may be considered medically necessary when the medical criteria and guidelines shown below are met.” Description section and References updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026.
Treatment For Opioid Use Disorder in Opioid Treatment Programs (OTPs)	References added. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No change to policy statement.
Viscocanalostomy and Canaloplasty	References updated. Policy Guidelines updated. Specialty Matched Consultant Advisory Panel review 6/2026. Medical Director review 6/2026. No change to policy statement.