CommercialCoverageMedium impact
Medical Policy Update May 6, 2026
Blue Cross NC·NC · General Surgery, Endocrinology·Medical Policy
Effective date
May 6, 2026
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated multiple medical policies effective May 6, 2026, including changes to genetic testing requirements, bariatric surgery guidelines, diagnostic testing frequencies, and various specialty procedures. Key changes include mandatory genetic counseling for genetic testing and updated coverage criteria for iron testing and genetic disorders.
Action Required
By May 6, 2026: Billing team must update procedures to require genetic counseling documentation for all genetic testing claims (codes in M2145 series). Update iron homeostasis testing (G2011) to limit frequency to once per month unless specified exceptions apply. Review and update encounter forms for bariatric surgery to reflect new endorsed procedures by American Society for Metabolic and Bariatric Surgery. Verify CPT code 81403 is active for muscular dystrophy testing and code 0172U for somatic genetic testing.