Blue Cross Blue Shield of North Dakota 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 September 21, 2020. Please see policy for changes. Medical policies are available at https://www.bcbsnd.com/providers/policies-precertification.
The following medical policies are new:
- Orthopedic Applications of Platelet Rich Plasma
- Actinic Keratosis
- Implantable Pulmonary Artery Pressure Measurement Device
- Electroencephalogram for Headaches
The following medical policies were revised:
- Manipulation Services
- Transcatheter Closure Devices for Septal Defects
- Dermatological Applications of Photodynamic Therapy
- Beds
- Cosmetic and Reconstructive Surgery
- Tumor Markers (CA-125)
- Laboratory Studies for Dx and Managing Inflammatory Bowel Disease
- Intraoperative Neurophysiologic Monitoring (Sensory-Evoked Potentials, Motor-EvokedPotentials, EEG Monitoring)
- External Hearing Aids, Auditory Brainstem Implant, Bone-Anchored Hearing Devicesand Audiological Testing
- Hematopoietic Cell Transplantation for Autoimmune Diseases
- Heart Transplantation
- Photodynamic Therapy (PDT) with Porfimer Sodium
- Autonomic Nervous System Function Testing
- Diagnosis and Treatment of Obstructive Sleep Apnea for Adults
- Arthrocentesis or Needling of Bursa
- Lower Limb Prostheses
- Oncologic Applications of Positron Emission Tomography Scanning
The following medical policies are consent policies:
- H-wave Electrical Stimulation
- WATS3D Biopsy (EndoCDx®)
- Ambulatory and Outpatient Cardiac Hemodynamic Monitoring of Heart Failure
- Deep Brain Stimulation
- Ankle-Foot/Knee-Ankle-Foot Orthosis
- Magnetoencephalography and Magnetic Source Imaging
- Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
- Impedance Cardiography in Hypertension
- Chronic Pain Programs
- Functional Neuromuscular Electrical Stimulation
- Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation
- Percutaneous Vertebroplasty and Sacroplasty
- Dynamic Splinting Devices
- Intraocular Lens
- Pap Smears with Medical Conditions
- Interferential Stimulator
- Cardiac Rehabilitation Programs, Phase II Outpatient
- Powered Exoskeletal Robotic Systems
- Devices Used for Treatment of obstructive Sleep Apnea in Adults
- Oxygen
The following medical policies had coding changes:
- Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemia
- Bioengineered Skin and Soft Tissue Substitutes
- Foot Orthotics for Conditions Other Than Diabetes
- Esophageal PH monitoring
- Transesophageal Endoscopic therapies for Gastroesophageal Reflux Disease
- Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease (LINX®)
- Pain Management of Peripheral Nerves by Injection
- Home Pulse Oximetry Device
- High Frequency Chest Wall Oscillation Devices
- Nerve Conduction Studies and Electromyography
- Bone Mineral Density Studies
- Drug Testing
- Vitamin D Assay
- Ambulatory Blood Pressure Monitoring (ABPM)
- Measurement of Exhaled Nitric Oxide
- Treatment of the Prostate
- Amniotic Fluid and Amniotic Membrane
- Foot Care Services
- Pulmonary Rehabilitation (HMK is Outpatient Pulmonary Rehabilitation)
- Allergy Immunotherapy
- Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon
- Experimental-Investigational
- Wearable Cardioverter-Defibrillator