Medical Policies Available Online Updates

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 Friday, Sept. 8, 2023. To review our medical policy changes, visit our BCBSND website under medical policies. 

The following medical policies are new effective Monday, Nov. 6, 2023:

  • Sports Physical
    • Procedure codes 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, and 99397
    • Diagnosis code Z02.5

 The following medical policies were revised:

  • Ambulatory Blood Pressure Monitoring (ABPM)
    • American Heart Association updated its recommendations along with addition of the below diagnosis codes:
      • M32.10, M32.11, M32.12, M32.13, M32.14, M32.15, M32.19, M32.8, M32.9, Z94.0, Z94.1, Z94.2, Z94.3, Z94.4, Z94.82, Z94.83 
  • Manipulation Under Anesthesia
    • References updated
  • Non-spinal Bone Growth Stimulation
    • References updated
  • Functional Neuromuscular Electrical Stimulation
    • Added Summary of Evidence  
  • Assisted Reproductive Technology (ART)
    • Added section for additional ART Cycles
    • Added verbiage for multiple pregnancy losses

 The following medical policies are consent policies:

  • Impedance Cardiography in Hypertension
  • Balloon Ostial Dilation of the Sinus and Implantable Sinus Stents
  • Intracellular Micronutrient Testing Panel
  • Interferential Stimulator
  • H-Wave Electrical Stimulation
  • Ambulatory and Outpatient Cardiac Hemodynamic Monitoring of Heart Failure
  • Implantable Pulmonary Artery Pressure Measurement Device
  • Cranial Electrotherapy Stimulation and Auricular Electrostimulation
  • Autonomic Nervous System Function Testing
  • Transcatheter Closure Devices for Septal Defects
  • Chronic Pain Programs
  • External Counterpulsation (ECP)
  • Transcatheter Mitral Valve Repair/Replacement
  • Cardiac Ablation Procedures
  • Subtalar Arthroereisis
  • Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation
  • Percutaneous Vertebroplasty and Sacroplasty
  • Bed-Accessories & Related Items
  • Cranial Orthosis for Plagiocephaly
  • Clinical Trials
  • Balloon Ostial Dilation of the Sinus and Implantable Sinus Stents
  • Speech Therapy

The following medical policies had coding changes:

  • Ambulatory Blood Pressure Monitoring (ABPM)
    • Diagnosis codes added due to American Heart Association updates
  • Cardiac Rehabilitation Programs, Phase II Outpatient
    • Diagnosis codes updated
  • Bone Turnover Markers for Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
    • Diagnosis codes updated
  • Myoelectric Prosthetic Components for the Upper Limb
    • Diagnosis codes updated/added: S48.0112D, S48.0112S, S68.729S, Z44.01, Z44.002, Z44.009, Z44.011, Z44.012, Z44.019, Z44.022, Z44.029, Z89.111. Z89.112, Z89.119, Z89.121, Z89.122, and Z89.129
  • Cardiac Monitors
    • Diagnosis code 121.11 for Covered diagnosis codes for procedure codes 93228 and 93229 should read as: I21.11  
  • Ablation of Miscellaneous Solid Tumors
    • Updated diagnosis codes for procedure codes 50250, 50542, 50592, and 50593
  • Lower Limb Prostheses
    • Following diagnosis codes were added: S78.011A, S78.011D, S78.011S, S78.012A, S78.012D, S78.012S, S78.019A, S78.019D, S78.019S, S78.021A, S78.021D, S78.021S, S78.022A, S78.022D, S78.022S, S78.029A, S78.029D, S78.029S, S78.111A, S78.111D, S78.111S, S78.112A, S78.112D, S78.112S, S78.119A, S78.119D, S78.119S, S78.121A, S78.121D, S78.121S, S78.122A, S78.122D, S78.122S, S78.129A, S78.129D, S78.129S, S78.911A, S78.911D, S78.911S,    S78.912A, S78.912D, S78.912S, S78.919A, S78.919D, S78.919S, S78.921A, S78.921D, S78.921S, S78.922A, S78.922D, S78.922S, S78.929A, S78.929D, S78.929S, Z96.651, Z96.652, Z96.653                             

The following medical policies will be archived / retiring:

  • Hepatobiliary System Imaging


Questions?
If you have additional questions regarding the medical policy changes, contact the appropriate Provider Service Center.

  • BCBSND 1-800-368-2312
  • Medicaid Expansion 1-833-777-5779