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Medical Policy Update October 15, 2025
Act
by Oct 15, 2025
Effective date
Oct 15, 2025
Identified
Jun 16, 2026
Summary
Blue Cross NC updated multiple medical policies effective October 15, 2025, including changes to cardiovascular risk assessment coverage criteria, coronavirus testing limitations, genetic testing terminology updates, and new CPT codes for prostate cancer testing. Most changes involve coverage criteria refinements and updated billing codes across various specialties.
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What to do
by Oct 15, 2025 · 4 steps
01Billing team must update system with new CPT codes for prostate cancer testing (add 0591U, 0534U, 0550U, 0572U, 84153, 84154, 86316 and remove 0053U, 0558U, 0559U).
02Remove codes 86318 and 87428 for coronavirus testing panels of 6+ antigens.
03Update coverage criteria for lipoprotein(a) testing to once per lifetime for patients 18+.
04Review genetic testing policies for updated terminology replacing 'mutations' with 'pathogenic/likely pathogenic variants'.
Codes mentioned
841538415486316863188742896040S0265
Original notice
Medical Policy Update October 15, 2025
bluecrossnc.com · Always check the source before changing claims.
Related changes
See all Blue Cross NC changes →Medical Policy Update for December 13, 2022HighEffective Dec 13, 2022 · Medical PolicyMedical Policy Update for February 21, 2024MediumEffective Feb 21, 2024 · Medical PolicyMedical Policy Update for May 15, 2024HighEffective May 15, 2024 · Medical PolicyMedical Policy Update for September 4, 2024MediumEffective Sep 4, 2024 · Medical PolicyBrowse every Blue Cross NC change in the policy list