Medical Policy 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 April 14, 2026. To review our medical policy changes, visit our BCBSND website under medical policies.

The following medical policy is new:

  • Placental Rapid Immunoassay for Detection of Fetal Membrane
    • Effective Sept. 1, 2026
    • Code impacted 84112

The following medical policies were revised:

  • Heart Transplantation Adult and Pediatric
    • Updated Literature
  • Fecal Analysis in the Diagnosis of Intestinal Dysbiosis
    • Updated Description
  • Speech Generating Devices
    • Updated Description
  • Intra-Arterial/Intravenous Therapeutic Procedures
    • Updated and separated arterial and venous criteria
  • Photodynamic Therapy with Porfimer Sodium
    • Updated criteria language by adding the word 'any'
  • Ultrasound Osteogenesis Stimulator
    • Updated criteria format, no change in criteria
  • Biofeedback
    • Added criteria language: Unsupervised biofeedback in the home setting is considered investigational for all indications
    • Removed Criteria for Biofeedback using capnometry guided respiratory intervention
  • Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy
    • 'Replacement' criteria added to policy
  • Diagnosis and Treatment of Obstructive Sleep Apnea in Pediatric Individuals
    • Criteria and Description updated
  • Diagnosis of Obstructive Sleep Apnea for Adults
    • Title of policy updated removed "treatment "
    • Criteria updated: removed Cpap criteria and Professional statement updated
  • Deep Brain Stimulation
    • Added cirteria and separated conditions
    • Removed Humanitiarina device exception criteria
  • Prostate Disease: Diagnosis, Staging, and Treatment
    • Updated Verbiage (Added "or more", added "severe" and removed "that are so severe.”),
    • Updated References,
    • Updated Professional Statements
  • Cardiac Ablation Procedures
    • Policy criteria streamlined for Hybrid Procedure
  • Hyperbaric Oxygen Therapy
    • Criteria reformatted with no changes to intent

The following medical policies are consent policies:

  • Home Pulse Oximetry Device
  • Osseointegrated Dental Implants
  • Rapid Platelet Function Assay - ASA
  • Mastectomy and Reconstructive Surgery
  • Diagnosis and Treatment of Male Sexual Dysfunction
  • Biomarkers in Risk Assessment and Management of Cardiovascular Disease
  • Leadless Cardiac Pacemakers
  • Laser Interstitial Thermal Therapy
  • Corpectomy, Vertebral
  • Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
  • Interspinous and Interlaminar Stabilization Distraction Devices
  • Cardiac Contractility Modulation Therapy
  • Sclerotherapy (Liquid or Microfoam)
  • Spider Veins, Treatment
  • Hip Resurfacing
  • Fecal Microbiota Transplantation
  • Hematopoietic Cell Transplantation: Experimental/Investigational Services
  • Hematopoietic Cell Transplantation: Solid Tumors
  • Speech Therapy
  • Confocal Laser Endomicroscopy
  • Intravascular Lithotripsy
  • Transanal Irrigation
  • Cognitive Rehabilitation
  • Category III T Codes

The following medical policies had coding changes:

  • Home Cervical Traction Therapy
    • Removed diagnosis codes M43.12 and M43.13
  • Intraoperative Neurophysiologic Monitoring (Sensory-Evoked Potentials, Motor-Evoked Potentials, EEG Monitoring)
    • Added diagnosis code: M41.30
    • Removed diagnosis codes G93.44, P11.3, P11.4, P11.5, P14.0, P14.1, P14.2, P14.3, P14.8
    • Q27.9, Q85.01, Q85.02, and Q85.09
    • I60.00, I60.10, I60.30, I60.50, and I65.29
    • S14.119D, S14.119S, S14.139A, S14.139D, S14.139S, S14.149A, S14.149D, S14.149S, S14.159A, and S14.159S
    • S22.000A, S22.000B, S22.000S, S22.001A, S22.001B, S22.001S, S22.002A, S22.002B, S22.002S, S22.008A, S22.008B, S22.008S, S22.009A, S22.009B, and S22.009S
    • S24.119A, S24.119S, S24.139A, S24.139S, S24.149A, and S24.149S
    • S32.000A, S32.000B, S32.001A, S32.001B, S32.001S, S32.002A, S32.002B, S32.002B, S32.002S, S32.008A, S32.008B, and S32.008S
    • S54.00XA, S54.00XS, S74.10XA, S74.10XS, S74.8X9A, S74.8X9S, S74.90XA, and S74.90XS
  • Durable Medical Equipment (DME)
    • Added April New Code: A4479
  • Urological Supplies
    • Added April New Code: A4318
  • Surgical Treatment of Obstructive Sleep Apnea
    • Added April New Code: C8007, C8008, C8009, C8011, C8012, and C8013
  • Skin Substitutes
    • Added April New Codes: A2040, A2041, A2042, A2043, A2044, G0681, G0682, G0683, G0684,
    • Q4418, Q4419, Q4421, Q4422, Q4423, Q4424, Q4425, Q4426, Q4427, Q4428, Q4429, Q4435, Q4436, Q4438, Q4439, and Q4440
  • Intra-Arterial/Intravenous Therapeutic Procedures
    • Added April New Code: C1743
  • Experimental/Investigational
    • Added April New Codes: A8005, A8006, A9294, C8010, G0680, and L2221
  • Lower Limb Prostheses
    • Added April New Code: L5992
  • Vitamin D Testing
    • Added diagnosis codes K50.00, K50.10, K50.80, K50.90, N20.0, N20.1, N20.2, N20.9, N21.0, N21.1, N21.8, and N21.9 (effective April 27, 2026)
  • Electroretinography
    • Added H35.011
  • Deep Brain Stimulation
    • Added procedure code: C1820
  • Hyperbaric Oxygen Therapy
    • Added procedure code E0446