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Notification of Medical Policy Revisions March 2023

Medical Policy

Revision
Electrical Stimulators-Neuromuscular

Annual Review

NCD 160.12

DME MAC Jurisdiction C; CGS: Functional Electrical Stimulation (FES)-Coverage and HCPCS Coding Revised

No CMS Updates; Minor Revisions only. Added codes A4560 and L8678 per the April 2023 code update.

Immunosuppressant Medications

Annual Review

LCD: L33824

LCA: A52474

No CMS Updates; Minor Revisions only

Sacral Nerve Stimulators for Urinary/Fecal Incontinence

Annual Review

NCD 230.18

BCBS Corporate Medical Policy on Sacral Nerve Neuromodulation/Stimulation of Pelvic Floor Dysfunction

Medicare National Coverage Determination Manual – 230.18

No CMS Updates; Minor Revisions only

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.

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