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 November 19, 2020. Please see policy for changes. Medical policies are available at www.BCBSND.com/web/providers/policies.
The following medical policies are new:
- Per-Oral Endoscopic Myotomy (POEM)
- Ultrafiltration in Decompensated Heart Failure (Aquapheresis Therapy)
- Endoscopic Radiofrequency Ablation/Cryotherapy
- Intensity-Modulated Radiotherapy of the Breast and Lung
- Intensity-Modulated Radiotherapy of the Prostate
- Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid
- Intensity-Modulated Radiotherapy: Abdomen and Pelvis
- Intensity-Modulated Radiotherapy: Central Nervous System Tumors
- Magnetic Resonance Imaging (MRI) of the Breast
- Endobronchial Valve Surgery
- Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
- Electromagnetic Navigational Bronchoscopy (ENB)
The following medical policies were revised:
- Tumor Treatment Fields
- Non-Powered Negative Pressure Wound Therapy System
- Wearable Cardioverter-Defibrillator
- Cardiac Ablation Procedures
- Diagnosis and Treatment of Obstructive Sleep Apnea for Adults
- Mastectomy and Reconstructive Surgery
- Liver Transplant
- Discography
- Seat Lift Mechanisms
- Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
- Obesity
- Outpatient Pulmonary Rehabilitation
- Miscellaneous Services
- Electrical Nerve Stimulation
- Hematopoietic Stem-Cell Transplantation for Multiple Myeloma and POEMS Syndrome
- Treatment of Hyperhidrosis
- Ultrasound Osteogenesis Stimulator
- Heart/Lung Transplant
- Small Bowel, Small Bowel/Liver and Multivisceral Transplant
- Fetal Surgery for Prenatally Diagnosed Malformations
- Negative Pressure Wound Therapy (NPWT) Pumps/Vacuum Assisted Closure (VAC) of Chronic
- Fecal Microbiota Transplantation
- Cosmetic and Reconstructive Surgery
- External Hearing Aids, Auditory Brainstem Implant, Bone-Anchored Hearing Devices and Audiological Testing
- Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
- Surgery
- Ambulatory Blood Pressure Monitoring (ABPM)
- Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas
The following medical policies are consent policies:
- Pneumatic Compression Devices
- Subtalar Arthroereisis
- Intraperitoneal Chemotherapy
- Prophylactic Mastectomy
- Meniscal Allografts and Other Meniscal Implants
- Mohs Micrographic Surgery (MMS)
- Cognitive Rehabilitation
- Measurement of Exhaled Nitric Oxide
- Total Ankle Replacement
- Ostomy Supplies
- Thermography (Thermogram)
- Wheelchairs and Options/Accessories
- Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
- Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
- Transcatheter Arterial Chemoembolization
- Oncologic Applications of Positron Emission Tomography Scanning
- Radiofrequency Facet Denervation
- Drug Testing
The following medical policies had coding changes: