CommercialBilling CodesMedium impact
Medical Policy Update October 15, 2025
Blue Cross NC·NC · Cardiology, Urology, Oncology +5 more·Medical Policy
Effective date
Oct 15, 2025
We identified it
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.
Action Required
By October 15, 2025: Billing 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). Remove codes 86318 and 87428 for coronavirus testing panels of 6+ antigens. Update coverage criteria for lipoprotein(a) testing to once per lifetime for patients 18+. Review genetic testing policies for updated terminology replacing 'mutations' with 'pathogenic/likely pathogenic variants'.