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 Feb. 10, 2026. To review our medical policy changes, visit our BCBSND website under medical policies.
The following medical policies are new:
- Upper Extremity Rehabilitation Systems
- Tonic Motor Activation System (TOMAC)
- ProAct: Adjustable Continence Therapy for Men
- Intravascular Lithotripsy
- Pelvic Floor Stimulation or Mechanotransduction as a Treatment of Urinary and Fecal Incontinence
The following medical policies were revised:
- Basivertebral Nerve Ablation
- Added Contraindication Criteria
- Beds - Accessories and Related Items
- Criteria language streamlined for low air loss therapy
- Cranial Orthosis for Plagiocephaly
- Quantity Level Limit language added to policy
- Bulking Agents for the Treatment of Urinary Stress Incontinence and Vesicoureteral Reflux
- Criteria change
- Digital Imaging Systems for the Detection and Evaluation of Diabetic Retinopathy
- Updated Professional Statements
- Ankle-Foot/Knee-Ankle-Foot Orthosis
- Changed body member or body extremity to limb
- Changed patient to individuals
- Added ALL and One or more
- Urological Supplies
- Updated language and references
- Myoelectric Prosthetic Components for the Upper Limb
- Updated criteria, description, and added professional statement
- Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
- Updated description and literature
- Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty
- Updated description
- Liver Transplant
- Updated criteria, added three conditions for investigational for Liver transplant
- Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease and Venous Thromboembolic Disease
- Updated description and literature
- Home Dialysis Equipment and Supplies
- Updated description
- Dry Needling of Trigger Points for Myofascial Pain
- Updated literature
- Cardiac Applications of Positron Emission Tomography Scanning
- Updated literature
- Meniscal Allografts and Other Meniscal Implants
- Updated literature
- WATS3D Biopsy (EndoCDx®)
- Updated description and literature
- Foot Care Services
- Updated literature
- Balloon Ostial Dilation of the Sinus and Implantable Sinus Stents
- Updated description
- Cosmetic Surgery vs. Reconstructive Surgery
- Updated literature
- Surgical Treatment of Femoroacetabular Impingement
- Updated description and literature
- Hyperbaric Oxygen Therapy
- Added criteria: Central Retinal Artery Occulusion
- Implantable Cardioverter Defibrillators
- Updated description, literature, and criteria,
- Added Policy Guidelines
- Lumbar Spinal Fusion
- Updated literature
- Artificial Intervertebral Disc Replacement
- Updated criteria for conservative therapy
The following medical policies are consent policies:
- Lymphoscintigraphy
- Braces and Supports
- Dynamic Splinting Devices
- Esophageal pH Monitoring
- Intraepidermal Nerve Fiber Density Testing
- Non-Surgical Management of Nasal Airway Obstruction
- Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
- Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions and Soft Tissue Wounds
- Manipulation Under Anesthesia
- Deep Brain Stimulation
- Ligation, Division, and/or Excision of Varicose Vein Cluster(s)
- Surgical Treatment of Obstructive Sleep Apnea
- Occupational Therapy (OT)
- Photodynamic Therapy with Porfimer Sodium
- Intraperitoneal Chemotherapy
- Ultraviolet Light Therapies
- Clinical Trials
- Physical Therapy
- Allergy Immunotherapy
- Cleft Palate/Lip Reconstruction
- Acupuncture for Pain Management, Nausea and Vomiting, and Opioid Dependence
- Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
- Ambulance Services: Air and Water Transportation
- Diagnosis and Treatment of Obstructive Sleep Apnea in Pediatric Individuals
- Nebulizers
The following medical policies had coding changes:
- Ablation of Liver Tumors
- Added 47384 under procedure codes
- Prostate Disease: Diagnosis, Staging, and Treatment
- Removed procedure codes 0421T, 0619T, and 52647
- Added procedure codes 52597 and 52443 to Covered Diagnosis codes
- Respiratory Assist Devices
- Added G35.D under diagnosis codes
- Experimental/Investigational
- Removed procedure codes: 37262, 37279 92972, C9764, C9765, C9766, C9767, C9772, C9773, C9774, and C9775- Moved to Policy S-346 Intravascular Lithotripsy,
- Removed procedure codes A4554 and E0743 moved to E-90Tonic Motor Activation System (TOMAC),
- Removed procedure codes 53451, 53452, 53453, and 53454 moved to S-775 ProAct: Adjustable Continence Therapy for Men
- Bone Mineral Density Studies
- Added procedure codes: 77085 and G0130
- Subfascial Endoscopic Perforator Surgery (SEPS)
- Removed procedure code 37500 and associated diagnosis codes
- Negative Pressure Wound Therapy Pumps/Vacuum Assisted Closure of Chronic Wounds
- Added diagnosis codes: I70.549 and L97.929
- Proton Beam Therapy
- Removed procedure code C9794
- Feeding Disorder Program
- Removed T1025-22
- Treatment of Benign or Premalignant Skin Conditions
- Removed procedure code J7309
- Treatment of Malignant Skin Lesions
- Removed procedure code J7309
- Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty
- Added procedure code: 22899
- Dry Needling of Trigger Points for Myofascial Pain
- Removed diagnosis code M79.1
- WATS3D Biopsy (EndoCDx®)
- Removed diagnosis codes K21.9, K21.00, and K21.01
- Balloon Ostial Dilation of the Sinus and Implantable Sinus Stents
- Added diagnosis codes J01.01, J01.11, and J01.31
- Surgical Treatment of Femoroacetabular Impingement
- Added procedure code: 27299
The following medical policies will be archived / retiring:
- Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors
The following medical policies have been updated:
- Skin Substitutes
- Added surgical codes for application
- Effective Jan. 1, 2026
- Experimental/Investigational
- Added procedure codes 92972, C9764, C9765, C9766, C9767, C9772, C9773, C9774, C9775, 63032, E0743, and A4554
- Effective Feb. 1, 2026
- Prostate Disease: Diagnosis, Staging, and Treatment
- PAE was placed in policy in error, 37242 and 37244 were removed from policy
- Effective Jan. 1, 2026
