CommercialCoverageMedium impact
Medical Policy Update September 10, 2025
Blue Cross NC·NC · Radiation Oncology, Neurology, Psychiatry +5 more·Medical Policy
Effective date
Sep 10, 2025
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield of North Carolina updated multiple medical policies on September 10, 2025, with key changes including new restrictions on IMRT for small cell lung cancer prophylactic cranial irradiation and expanded limitations on quantitative EEG testing for mental health diagnoses. Most updates were reference updates with no policy statement changes.
Action Required
By September 10, 2025: Billing team must update prior authorization requirements for IMRT procedures - confirm prophylactic cranial irradiation for small cell lung cancer is now not covered. Stop billing quantitative EEG (qEEG) theta:beta ratio testing for mental health diagnoses including depression, PTSD, anxiety, autism spectrum disorders as these are now considered investigational. Review skin graft billing to ensure cadaver-derived grafts for large traumatic wounds meet new coverage criteria. Update encounter forms to reflect these changes.