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 Nov. 19, 2024. To review our medical policy changes, visit our BCBSND website under medical policies.
The following medical policies are new:
- Lymphoscintigraphy
- Bariatric Surgery (S-331)
The following medical policies were revised:
- Patient Lifts
- Bullets reworded and arranged, and removal of 'and' in the non-covered section of policy.
- Digital Imaging Systems for the Detection and Evaluation of Diabetic Retinopathy and Intraocular Photography
- Verbiage changes, removal of 'or' after bullets, and updated professional statements.
- Chronic Pain Programs
- Removed "Prior Approval is required"
- Wearable Cardioverter-Defibrillator
- Removed the following statements: 'at least 1 year of age or older' and 'device must be worn for 22 hours per day.' Rewording of criteria and removal of the New York Heart Association Functional Classification (NYHA of Heart Disease) and the Modified Ross Heart Classification for Children grids.
The following medical policies are consent policies:
- Respiratory Assist Devices
- Ultrasound Osteogenesis Stimulator
- Clinical Trials
- Thermography (Thermogram)
- Foot Care Services
- Heart Transplantation Adult and Pediatric
- Transcatheter Closure Devices for Septal Defects
- Frenectomy or Frenotomy for Ankyloglossia
- Intensity-Modulated Radiotherapy: Abdomen, Pelvis and Chest
- Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid
- Electroretinography • Electromagnetic Navigational Bronchoscopy (ENB)
- Hematopoietic Cell Transplantation: Solid Tumors
- Cognitive Rehabilitation
- Gender Affirmation Treatment
- Functional Neuromuscular Electrical Stimulation
- Surgical Treatment of Obstructive Sleep Apnea
- Laboratory Studies for Diagnosing and Managing Inflammatory Bowel Disease
- Electroencephalogram
- Corneal Topography/Computer-Assisted Corneal Topography/ Photokeratoscopy
- Orthopedic Applications of Platelet-Rich Plasma
- Intensity-Modulated Radiotherapy: Cancer of the Prostate
- Intensity-Modulated Radiotherapy: Central Nervous System Tumors
- Peer Support
- Biomarkers in Risk Assessment and Management of Cardiovascular Disease
The following medical policies had coding changes:
- Posterior Tibial Nerve Stimulation
- October New Codes
- Adding procedure codes A4545 and E0737.
- Basivertebral Nerve Ablation
- October new codes
- Adding diagnosis codes M51.360, M51.361, M51.362, M51.369, M51.370, M51.371, M51.372, M51.379
- Removing diagnosis codes M51.36 and M51.37 for procedure codes 64628 and 64629
- Hematopoietic Cell Transplantation: Blood Cancers
- October new codes:
- Removed diagnosis codes C86.0, C86.1, C86.2, C86.3, C86.4, C86.5, C86.6, C88.4, and C88.8.
- Added diagnosis codes C88.40, C88.41, C83.390, C83.398, C86.00, C86.01, C86.10, C86.11, C86.20, C86.21, C86.30, C86.31,C86.40, C86.41, C86.50, C86.51, C86.60, C86.61 C88.80 and C88.81.
- Amniotic Membrane and Amniotic Fluid
- October new codes:
- Adding new codes: Q4334, Q4335, Q4336, Q4337, Q4338, Q4339, Q43340, Q4341, Q4342, Q4343, Q4344, and Q4345.
- Rabies Vaccination and Immune Globulin
- Annual review for ND with addition of diagnosis codes: W53.29XA, W53.29XD, W53.89XA, W53.89XD, W54.8XXA, W548XXD,W55.09XA, W55.09XD, W55.19XA, W55.19XD, W55.29XA, W55.29XD, W55.39XA, W55.39XD, W55.49XA, W55.49XD, W55.59XA,W55.59XD, W55.89XA, W55.89XD, W56.09XA, W56.09XD, W56.19XA, W56.19X, W56.29XA, W56.29XD, W56.39XA, 56.39XD,W56.49XA, W56.49XD, W56.59XA, W56.59XD, W56.89XA, W56.89XD, W59.29XA, W59.29XD, W61.09XA, W61.09XA, W61.09XD, W61.09XD, W61.12XA, W61.12XD, W61.19XA, W61.19XA, W61.19XD, W61.19XD, W61.29XA, W61.29XD, W61.59XA, W61.59XD, W61.69XA, W61.69XD, W61.99XA, and W61.99XD.
- Intra-Arterial/Intravenous Therapeutic Procedures
- Annual review for ND with diagnosis code update. Adding T82.49XA, T82.49XS, T82.818D, T82.818S, T82.848D, T82.848S, T82.868D,T82.868S, T82.9XXA, and T82.9XXD.
- Cardiac Ablation Procedures
- Annual review for ND with removal of diagnosis code I47.1
- Deep Brain Stimulation
- Annual review for ND with diagnosis coding update; adding: G20.BC, G24.01 and G24.02.
- Meniscal Allografts and Other Meniscal Implants
- Annual review for ND with diagnosis updates.
- Removing duplicates and S83.200, S83.202, S83.203, S83.204, S83.205, S83.206,S83.207, S83.209, S83.211, S83.212, S83.222, S83.229, S83.231, S83.232, S83.239, S83.241, S83.242, S83.249, S83.251, S83.252,S83.259m S83.261, S83.262, S83.269, S83.271, S83.272, S83.279, S83.281 , S83.282, S83.289 o Added S83.31XA. Tumor Markers
- Added covered diagnosis codes C53.1, C53.8, C53.9, C54.0, C54.8, C78.01, C78.02, C78.1, C78.2, C78.30, C78.39, C78.4, C78.5, C78.7, C78.89, C79.81, C79.89, C79.9, D06.0, D06.1, D06.7, D06.9, D07.0, D09.8, D09.9, D48.3, D48.4, Z85.44, Z85.89, and Z15.02 to procedure code 86304.
- Added covered diagnosis codes C7A.010, C7A.011, C7A.012, C7A.019, C7A.020, C7A.021, C7A.022, C7A.023, C7A.024, C7A.025, C7A.026, C7A.029, C7A.090, C7A.091, C7A.092, C7A.093, C7A.094, C7A.095, C7A.096, C7B.1, D3A.010, D3A.011, D3A.012, D3A.020, D3A.021, D3A.022, D3A.023, D3A.024, D3A.025, D3A.026, D3A.029, D3A.090, D3A.091, D3A.092, D3A.093, D3A.095, D3A.096, D3A.098, and D3A.8 to procedure codes 86316.
- Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
- Removed diagnosis codes: I63.019, I63.039, I63.119, I63.13, I63.139, I63.219, I63.239, I63.319, I63.329, I63.339, I63.419, I63.429,I63.439, I63.449, I63-519, I63.529, I63.539, I63.549, I66.09, I66.19, and I66.29.
- Coronary Revascularization
- Removed procedure codes 92920, 92921, 92924, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, and 92944.
- Physical Therapy
- Adding diagnosis codes to procedure code 97116: F82, G10, G20.A1, G20.A2, G35, G71.11, G80.0, G80.1, G80.2, G80.3, G80.4, G80.8, G80.9, G95.20, G95.29, H51.8, I63.81, I63.89, I63.9, I69.153, I69.154, I69.353, I69.354
- M08.00, M16.11, M16.12, M16.2, M17.11, M17.12, M17.2, M19.071, M19.072, M21.70, M21.721, M21.722, M25.551, M25.552, M25.561, M25.562, M48.02, M50.10, M54.16, M62.81, M62.89, M79.604, M79.605, M79.661, M79.662, M99.05
- P07.36, P07.39, Q05.2, Q05.9, R26.2, R26.89, R41.840,R50.10, R53.1, R62.50
- S06.9X6A, S06.9X6D, S06.9X6S, S06.9X9A, S06.9X9D, S06.9X9S, S50.892D
- S72.051A, S72.051B, S72.051C, S72.051D, S72.051E, S72.051F, S72.051G, S72.051H, S72.051J, S72.051K, S72.051M, S72.051N , S72.051P, S72.051Q,S72.051R, S72.051S, S72.052A, S72.052B, S72.052C, S72.052D, S72.052E, S72.052F, S72.052G, S72.052H, S72.052J, S72.052K,S72.052M, S72.052N , S72.052P, S72.052Q, S72.052R, S72.052S, S72.321A, S72.321B, S72.321C, S72.321D, S72.321E, S72.321F,S72.321G, S72.321H, S72.321J, S72.321K, S72.321M, S72.321N , S72.321P, S72.321Q, S72.321R, S72.321S
- S82.142A, S82.142A, S82.142B, S82.142C, S82.142D, S82.142E, S82.142F, S82.142G, S82.142H, S82.142J, S82.142K, S82.142M, S82.142N, S82.142P, S82.142Q, S82.142R, S82.142S, S82.201A, S82.201B, S82.201C, S82.201D, S82.201E, S82.201F, S82.201G, S82.201H, S82.201J, S82.201K, S82.201M, S82.201N, S82.201P, S82.201Q, S82.201R, S82.201S, S82.61XA, S82.61XB, S82.61XC, S82.61XD, S82.61XE, S82.61XF, S82.61XG, S82.61XH, S82.61XJ, S82.61XK, S82.61XM, S82.61XN, S82.61XP, S82.61XQ, S82.61XR, S82.61XS, S82.821A, S82.821B, S82.821C, S82.821D, S82.821E, 82.821F, S82.821G, S82.821H, S82.821J, S82.821K, S82.821M, S82.821N, S82.821P, S82.821Q, S82.821R, S82.821S, S82.892A, S82.892B, S82.892C, S82.892D, S82.892E, S82.892F, S82.892G, S82.892H,S82.892J, S82.892K, S82.892M, S82.892N, S82.892P, S82.892Q, S82.892R, S82.892S
- S83.512A, S83.512B, S83.512C, S83.512D,S83.512E, S83.512F, S83.512G, S83.512H, S83.512J, S83.512K, S83.512M, S83.512N, S83.512P, S83.512Q, S83.512R, S83.512S,S86.012A
- S86.012B, S86.012C, S86.012D, S86.012E, S86.012F, S86.012G, S86.012H, S86.012J, S86.012K, S86.012M, S86.012N,S86.012P, S86.012Q, S86.012R, S86.012S, S86.401A,S86.401B, S86.401C, S86.401D, S86.401E, S86.401F, S86.401G, S86.401H,S86.401J, S86.401K, S86.401M, S86.401N, S86.401P, S86.401Q, S86.401R, S86.401S
- Z08, Z09, Z47.89, and Z98.890.
- Experimental/Investigational
- Adding procedure codes 0331T, 0332T, 0614T, and M0076
- Knee Orthosis
- Adding diagnosis codes
- Cosmetic Survery vs. Reconstructive Surgery
- Added procedure codes 17110, 17111, 17999, and 96900
The following medical policies will be archived / retiring:
- Polysomnography (PSG) for Non-Respiratory Sleep Disorders
- Bariatric Surgery (G-24)
