Blue Cross Blue Shield of North Dakota (BCBSND) continually develops and revises medical policies in response to rapidly changing medical technology. Our commitment is to update the provider community as medical policies are adopted and/or revised. Benefit determinations are made based on the medical policy in effect at the time of service. The following medical policies were reviewed by the Internal Medical Policy Committee on July 16, 2024. To review our medical policy changes, visit our BCBSND website under medical policies.
The following medical policies were revised:
- Prostate Disease: Diagnosis, Staging, and Treatment
- Added bullet: Transperineal laser ablation for the treatment of Benign Prostate Hypertrophy (BPH) to the BPH section.
- Updated the Professional statements and grid
- Devices Used for the Treatment of Sleep Apnea in Adults
- Added statement: 'Intra-oral devices do not meet the above criteria if there is a signed affidavit refusing Continuous Positive Airway Pressure (CPAP) treatment, and therefore considered not medically necessary'
- Bioengineered Skin and Soft Tissue Substitutes
- Changed Experimental/Investigational (E/I) to not medically necessary
- Measurement of Exhaled Nitric Oxide
- Changes made to the wording in diagnosis section
- Endobronchial Valve Surgery
- Policy language updated
- Endoscopic Stricturotomy
- Policy language updated
- Braces and Supports
- Removed Unna boot section
The following medical policies are consent policies:
- Home Dialysis Equipment and Supplies
- Automated External Defibrillators for Home Use
- Chelation Therapy for Off-Label Uses
- Phototherapy for Psychiatric Disorders
- Confocal Laser Endomicroscopy
- Nucleoplasty and Biacuplasty
- Phrophylactic Mastectomy
- Transcatheter Pulmonary Valve Implantation
- Orthopedic Applications of Stem-Cell Therapy
- Aqueous Shunts and Stents for Glaucoma
- Intense Pulsed Light Therapy for the Treatment of Dry Eye Disease
- Ultra-Rapid Opiate Detoxification (UROD)
- Chronic Wound Management
- Fecal Microbiota Transplantation
- Percutaneous Left Atrial Appendage Closure Devices
- Nerve Ablation and Injection
- Corneal Surgery to Correct Refractive Errors, Phototherapeutic Keratectomy, and Corneal Collagen Cross-Linking
- Lipedema
- Intensity-Modulated Radiotherapy of the Breast and Lung
- Miscellaneous
- Hospice
- Hospice (Medicaid Expansion only)
- Percutaneous Left Atrial Appendage Closure Devises
The following medical policies had coding changes:
- Prostate Disease: Diagnosis, Staging, and Treatment
- Added July new code 0867T
- Added covered diagnosis codes N42.31, N42.32, R97.20 and R91.21 for procedure codes: 0421T, 0582T, 52441, 52442, 52450, 52601, 52630, 52640, 52647, 52648, 52649, 53850, 53852, 53854, 55801, 55810, 55812, 55815, 55821, 55831, 55840, 55842, 55845, 55866, and 55867
- Gastric Electrical Stimulation, Gastric Pacing
- Added new code 0868T
- Removed deleted code C9787
- Amniotic Membrane and Amniotic Fluid
- Added July new codes Q4311, Q4312, Q4313, Q4314, Q4315, Q4316, Q4317, Q4318, Q4319, Q4320, Q4321, Q4322, Q4323, Q4324, Q4325, Q4326, Q4327, Q4328, Q4329, Q4330, Q4331, Q4332, and Q4333
- Removed procedure codes Q4210 and Q4277
- Experimental/Investigational
- Add July new code 0869T, 089T, 0890T, 0891T and 0892T as ND specific. 0882T, 0883T, 0881T, 0875T, 0877T, 0878T, 0879T, 0880T, 0870T, 0871T, 0872T, 0873T, 0874T, 0875T, 0884T, 0885T, 0886T, 0894T, 0895T, 0896T, C9901, 0897T, 0899T, 0900T, 0888T, 0898T, and 0893T
- Removed deleted code C9790
- Physical Therapy
- Added 97550, 97551, and 97552 to Habilitative section of the policy
- Speech Therapy
- Added 97550, 97551, and 97552 to Habilitative section of the policy
- Urological Supplies
- Removed diagnosis coding for procedure code A4357
- Treatment of Abnormal Uterine Bleeding and Uterine Fibroids
- Removed diagnosis codes for procedure code 75894
- Bulking Agents for the Treatment of Urinary Stress Incontinence and Vesicoureteral Reflux
- Annual review for ND, removed dx codes N13.729 and N13.739
- Braces and Supports
- Removed codes 27125, 27130, 27132, 27134, 27137, 27138, 27140, 29861, 29862, 29863, 89914, 29915, and 28816.
- Added L1681 (the postoperative hip brace section).
- Removed Unna boot section and removed deleted code A4656.
- Discectomy
- Annual review for ND, updated diagnosis codes, added M50.03, M51.A0, and M51.A1
- Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease (LINX®)
- Added procedure code 43289
- High Resolution Anoscopy (HRA)
- Added diagnosis codes C44.520, D07.1, R85.81, and R85.82 to procedure codes 46601 and 46607
- Removed diagnosis code N87.2.
- Telehealth
- Added procedure code 99450
- Diabetic Services and Supplies
- Removed codes A4226, A4238, A4239, A9276, A9277, A9278, E2102, E2103, 0446T, 0447T, 0448T, 95249, 95250, and 95251
The following medical policies will be archived / retiring:
- Transtympanic Micropressure Applications as a Treatment of Meniere's Disease
- Fetal Surgery for Diagnosed Malformations
- Arthrocentesis or Needling of Bursa
