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 June 9, 2026. To review our medical policy changes, visit our BCBSND website under medical policies.
The following medical policies are new:
- Vagus Nerve Stimulation
- Restorative Neurostimulation for Low Back Pain
- Lysis of Epidural Adhesions
- Transcatheter Aortic Valve Implantation for Aortic Stenosis
- Phrenic Nerve Stimulation
The following medical policies were revised:
- Monitored Anesthesia Care
- Updated Language
- Tumor Treatment Fields
- Reformatted Criteria
- Removed Criteria for Recurrent Glioblastoma, moving forward will be experimental/investigational
- Software removed from E/I and into criteria
- Wearable Cardioverter-Defibrillator
- Criteria reformatted with no change to intent
- Cochlear Implantation
- Criteria reformatted with no change to intent
- Lung and Lobar Lung Transplantation
- Criteria reformatted with no change to intent
- Heart-Lung Transplantation
- Criteria reformatted with no change to intent
- Pancreas Transplant
- Criteria reformatted with no change to intent
- Mastectomy and Reconstructive Surgery
- Removed Criteria for Mastectomy for Fibrocystic Breasts. Removed Criteria for Mastectomy for Fibrocystic Breasts
- Updated Criteria Language regarding removal of implants due to breast implant associated anaplastic large cell lymphoma
- Prophylactic Mastectomy
- Added criteria for Mastectomy for fibrocystic breasts
- Added Procedure codes: 19301, 19302, 19305, 19306, 19307
- Added diagnosis codes N60.91, N60.92, N60.99
- Decompression and Discectomy, Thoracic
- Criteria Updated: Updated timeframes for conservative therapy
- Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- Criteria reformatted with no change to intent
- Removed diagnosis code M51.04
- Electrical Nerve Stimulation
- Removed Procedure Codes: 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 64575, 93150, 93152, 93153, 95970, 95971, 95976, 95977, E0735, L8695, L8696
- All Diagnosis codes removed
- Updated criteria, 3 Sections removed and added to 3 new Policies Z-114, S-777, S-779
- Treatment of Abnormal Uterine Bleeding and Uterine Fibroids
- Updated Description, Transcatheter UAE, Radiofrequency Ablation, Endometrial Ablation and Experimental/Investigational bullet points
- Added Procedure Code 0071T and 0072T
- Removed Procedure Code 36245, 36246, 36247, 36248, and 75894
- In Vitro Allergy Testing
- Removed Quantity level limits on 86003 and 86008
- Bioengineered Skin and Amniotic Membrane Substitutes
- Added length of time in description
The following medical policies are consent policies:
- General Anesthesia for Oral and Maxillofacial Surgery and Dental Services
- H-wave Electrical Stimulation
- Measurement of Exhaled Nitric Oxide
- Autonomic Nervous System Function Testing
- Home Health- Extended Hours
- Ilizarov Bone Lengthening
- Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
- Allergy Skin Testing
- Cerebral Oxygenation Monitoring using Near Infrared Spectroscopy (NIRS)
- Noninvasive Techniques for the Evaluation and Monitoring of Patients with Chronic Liver Disease
- Measurement of Serum Antibodies to Selected Biologic Agents
- Covid-19 Antibody Testing
- Thermography (Thermogram)
- Hospice
- Apheresis Therapy
- Nucleoplasty and Biacuplasty
- Nerve Ablation and Injection
- Bone Mineral Density Studies
- Pain Management by Injection
The following medical policies had coding changes:
- Category III T Codes
- Removed termed codes: 0623T, 0624T, 0625T, 0626T, 0631T
- Added Procedure Codes: 0415T, 0416T
- July New Codes: Added Procedure Codes: 1026T, 1027T, 1028T, 1029T, 1030T, 1031T, 1032T, 1033T, 1034T, 1035T, 1036T, 1037T, 1038T, 1039T, 1040T, 1041T, 1042T, 1043T, 1044T, 1045T, 1046T, 1047T, 1048T, 1049T, 1050T, 1051T, 1052T, 1053T
- Experimental/Investigational
- Added Procedure Codes: 0024U, 0061U, 0062U
- Removed Codes: 0491U, 0492U, 0546U, 0548U, 0550U, 0551U, 33267, 33268, 33269, 33440, 33900, 33901, 33902, 33903, 33904, 36837, 64913, 90666, 90667, 90668, 91022, 92145, 93896, 93897, 93898, 95919, 97007, 97008, 97009, A4563, A4593, A4594, A8005, A8006, A9268, A9269, A9294, C1601, C1602, C1734, C1762, C8000, C8004, C8010, C9758, C9759, C9779, C9780, C9782, C9783, C9793, C9901, E0683, E2001, E3000, G0680, K1037, L2221, S3902, S9025
- July New Codes: Added Procedure Code G0685
- Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
- Removed diagnosis code M51.04
- Prostate Disease: Diagnosis, Staging, and Treatment
- July New Codes: Added Procedure Code C8014
- Corneal Surgery to Correct Refractive Errors and Phototherapeutic Keratectomy, and Corneal Collagen Cross-Linking
- July New Codes: Added Procedure Code J2789
The following medical policies will be archived / retiring:
- Dynamic Splinting Devices
The following medical policies have been updated:
- Allergy Skin Testing
- Removed termed diagnosis codes: Z91.011, Z91.012
- Added Updated diagnosis codes: Z91.0110, Z91.0111, Z91.0112, Z91.0120, Z91.0121, Z91.0122
- Drug Testing
- Added clarifying language that this policy does not address urine drug testing in the Emergency
