Blue Cross Blue Shield of North Dakota (BCBSND) continually 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 our Internal Medical Policy Committee on Aug. 11, 2026. To review our medical policy changes, visit our BCBSND website under Medical Policy Search | BCBSND.
The following medical policies are new:
- No new policies this IMPC
The following medical policies were revised:
- Gastric Electrical Stimulation, Gastric Pacing
- Criteria reformatted with no change in intent
- Renal Denervation System
- Medical Necessity Criteria being added to policy. Updated literature, added procedure code: C1736
- Ultrasound Osteogenesis Stimulator
- Criteria language updated and timelines
- Proton Beam Therapy
- Criteria reformatted with no change in intent
- Non-Spinal Bone Growth Stimulation
- Criteria reformatted with no change in intent
- Cochlear Implantation
- Updated criteria for replacement and added quantity level limits
- High Frequency Chest Wall Oscillation Devices
- Criteria reformatted with no change to intent
- Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine
- Criteria reformatted with no change to intent. Updated literature and references
- Artificial Intervertebral Disc Replacement
- Criteria reformatted with no change to intent
- Spinal Cord and Dorsal Root Ganglion Stimulation
- Criteria reformatted with no change to intent
- Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography
- Reformatted and updated criteria, updated literature
- Lipedema
- Reformatted criteria with no change to intent
- Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment
- Updated and reformatted criteria, updated literature
- Surgical Treatment of Femoroacetabular Impingement
- Criteria reformatted with no change to intent
- Radiofrequency Facet Denervation
- Criteria reformatted with no change to intent
- Cardiac Applications of Positron Emission Tomography Scanning
- Criteria reformatted with no change to intent
- Bariatric Surgery
- Criteria reformatted with no change to intent
- Ambulance Services: Air and Water Transportation
- Criteria reformatted with no change to intent
- Diagnosis of Obstructive Sleep Apnea in Adults
- Criteria updated by adding to in lab sleep study. Added diagnosis codes: F51.19, G47.10, G47.11, G47.12, G47.13, G47.19, G47.30, G47.33, G47.39, R63.4, Z68.35, Z68.36, Z68.37, Z68.38, Z38.69, Z68.41, Z68.42, Z68.43, Z68.44, Z68.45
- Diagnosis of Obstructive Sleep Apnea in Pediatric
- Removed procedure codes: E0601, E0618, E0619, E0485, E0486, K1027, 42950. Updated Title removed Treatment and criteria moved to E-20, Criteria removed from procedure codes - moved to E-20 and S-280, Removed Covered Diagnosis Code for Procedure Code E0601: G47.33
- Surgical Treatment of Obstructive Sleep Apnea
- Criteria reformatted with no change to intent
- Cosmetic Surgery vs. Reconstructive Surgery
- Criteria reformatted with no change to intent
- Removed procedure codes:19325, L8600. Removed criteria for Augmentation Mammoplasty, Updated criteria for Panniculectomy, Rosacea Treatment, Hair Removal, Dermabrasion, Mastectomy for gynecomastia, description updated
- Assisted Reproductive Technology
- Removed Criteria for Cryopreservation - based off benefits
- Devices Used for the Treatment of Obstructive Sleep Apnea in Adults and Pediatrics
- Added Pediatric to title, updated criteria, literature, revised format, separated and updated criteria for oral appliance for severe, moderate and mild OSA
- Corneal Surgery to Correct Refractive Errors and Phototherapeutic Keratectomy, and Corneal Collagen Cross-Linking
- Adding J2787, adding more criteria under Corneal Collagen Cross-Linking section, and updating references
- Mastectomy and Reconstructive Surgery
- Updated criteria for breast implant removal and reconstruction. removed table from policy for implant removal
- Wheelchairs (WC) and Options/Accessories
- Updated Criteria, descriptions, added criteria for replacement wheelchairs. remove diagnosis code: G35.C2
- Intense Pulsed Light Therapy for the Treatment of Dry Eye Disease
- Annual review for ND. Changed from not medically necessary to E/I
- Hematopoietic Cell Transplantation: Blood Cancers
- Criteria reformatted without change to intent
The following medical policies are consent policies:
- Repair, Maintenance, and Replacement of Durable Medical Equipment (DME)
- Intraocular Lens
- Powered Exoskeletal Robotic Systems
- Kidney Transplant
- Corneal Transplantation
- Electrical Stimulation Devices for the Treatment of Arthritis
- Proton Beam Radiation Therapy - FM HomeBuilders Consortium and Eide Bailly Only
- Interferential Current Stimulation
- Automated External Defibrillators for Home Use
- Ambulatory Blood Pressure Monitoring
- Myocardial Strain Imaging
- Chromoendoscopy as an Adjunct to Colonoscopy
- Knee Orthosis
- Ocular Photodynamic Therapy (PDT)
- Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
- Laminectomy
- Composite Tissue Allotransplantation of the Hand
- Discectomy
- Surgical Treatments for Breast Cancer-Related Lymphedema
- Electric Breast Pumps
- Minimally Invasive Treatments for Chronic Rhinitis
- Endoscopic Stricturotomy
- Manipulation Services
- Photography
The following medical policies had coding changes:
- Experimental/Investigational
- Removed procedure code: C1736. code moved to policy S-342
- Vitamin D Testing
- Adding 82652, Code moved from L-191
- Intracellular Micronutrient Testing Panel
- Removing 82652 (moved to L-308), adding 82128
The following medical policies will be archived/retiring:
- Dynamic Splinting Devices
The following medical policies have been updated:
- Restorative Neurostimulation for Low Back Pain
- Updated policy description
- Allergy Testing
- Title change, removed the word skin
- Aqueous Shunts and Stents for Glaucoma
- Added H25.12 to covered diagnosis codes
