CommercialCoverageHigh impact
Medical Policy Update December 10, 2025
Blue Cross NC·NC · Gastroenterology, Infectious Disease, Internal Medicine +1 more·Medical Policy
Effective date
Dec 10, 2025
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield of North Carolina updated multiple medical policies effective December 10, 2025, with significant changes to hepatitis testing coverage (adding HCPCS G0567 and expanding immunocompromised patient criteria), nucleic acid probe testing (removing several direct probe tests from coverage), and pancreatic enzyme testing (removing amylase coverage for most indications).
Action Required
Immediately: Update billing system to include new HCPCS code G0567 for hepatitis testing in immunocompromised patients. Stop billing codes 87480, 87481, and 87482 for direct probe nucleic acid testing - these are now non-covered. Remove serum amylase testing from most pancreatic enzyme panels except for pancreatic cyst fluid analysis. Update encounter forms and provider documentation requirements for hepatitis testing frequency changes (HCV antibody testing now every 3 months for high-risk patients). Failure to comply will result in claim denials.