Blue Cross Blue Shield of North Dakota (BCBSND) regularly 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 January 26, 2023. To review our medical policy changes, visit our BCBSND website under medical policies.
The following medical policies are new:
The following medical policies were revised:
- Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Surgery (MRgFUS)
- Changed the criteria layout; no change in criteria
- Islet Cell Transplantation
- Acupuncture for Pain Management, Nausea and Vomiting, and Opioid Dependence
- Updating references
- Adding summary of evidence
- Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
- Updating references
- Adding summary of evidence
- Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
- Updating references
- Adding summary of evidence
- Dry Needling of Myofascial Trigger Points
- Updating references
- Adding summary of evidence
- Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- Updating references
- Adding summary of evidence
- Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)
- Adding summary of evidence
- Surgical Treatment of Femoroacetabular Impingement
- Updating references
- Adding summary of evidence
- Radioembolization for Primary and Metastatic Tumors of the Liver
- Updating references
- Adding summary of evidence
- Updating guidelines
- Lumbar Spinal Fusion
- Updating references
- Adding summary of evidence
- Pneumatic Compression Devices
- Adding head and neck as experimental / investigational
- Fetal Surgery for Prenatally Diagnosed Malformations
- Now medically necessary for:
- Fetoscopic Endoluminal Tracheal Occlusion (FETO) surgery
- Congenital Diaphragmatic Hernia
- Cognitive Rehabilitation
- Adding term neuropsychologist
- Foot Care Services
- Adding:
- Peripheral circulatory disorder; or
- Peripheral neuropathic disease
- Respiratory Assist Devices
- Adding information to description section
- Biofeedback
- Administrative changes, i.e., changing % to percent
- Administrative changes, i.e., changing % to percent
The following medical policies are consent policies:
- Ultra-Rapid Opiate Detoxification (UROD)
- Wheelchairs (WC) and Options/Accessories
- Per-Oral Endoscopic Myotomy (POEM)
- Telehealth
- Treatment of Abnormal Uterine Bleeding and Uterine Fibroids
- Chronic Wound Management
- Cleft Palate/Lip Reconstruction
- Ambulance Services: Air and Water Transportation
- Ambulance Services: Ground Transportation
- Medication Assisted Treatment (MAT)
- Cochlear Implantation
- CT (Virtual) colonoscopy
- Artificial Intervertebral Disc Replacement
- Temporomandibular Joint (TMJ) Dysfunction
- In Vitro Allergy Testing
- Vitamin D Assay
- Measurement of Exhaled Nitric Oxide
- Recombinant and Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non-Orthopedic Conditions
The following medical policies had coding changes:
- External Hearing Aids, Auditory Brainstem Implant, Bone-Anchored Hearing Devices and Audiological Testing
- Adding 69729 and 69730, new codes effective 1/1/2023
- AposTherapy System
- Removal of Dx codes from medical policy
- Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- Update Dx codes
- Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Surgery (MRgFUS)
- Remove 61736 and 61737
- Fetal Surgery for Prenatally Diagnosed Malformations
- Adding S2400 and S2404
- Cognitive Rehabilitation
- Updating Dx code
- Fecal Microbiota Transplantation
- Updating Dx code
- Foot Care Services
- Update Dx codes
- Experimental-Investigational
- Following codes will now be in S-278: 0408T, 0409T, 0410T, 0411T, 0413T, 0414T, 0417T, 0418T
- Following codes will now be in S-279: 0656T, 0657T
- Remove E/I denial for: 0415T, 0416T, C1824
