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Medical Policy Update for July 1, 2025
Act
by Jul 1, 2025
Effective date
Jul 1, 2025
Identified
Jun 16, 2026
Summary
Blue Cross NC updated multiple medical policies effective July 1, 2025, including coverage criteria changes for autism behavioral treatment, allergen testing, biomarker testing, and various genetic testing procedures. New CPT codes were added for Alzheimer's biomarkers (0568U), capsule endoscopy (0977T), and prostate cancer testing (0558U, 0559U), while some existing codes were removed or replaced.
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What to do
by Jul 1, 2025 · 4 steps
01Billing team must update coding systems to include new CPT codes 0568U (Alzheimer's biomarkers), 0977T (capsule endoscopy), 0558U and 0559U (prostate cancer testing), and 81210, 81403, 81479 (genetic testing).
02Remove code 0352U and replace with 0557U for vaginitis testing.
03Update prior authorization requirements for autism behavioral treatment and genetic counseling requirements for epilepsy testing.
04Review coverage criteria changes for allergen testing and biomarker testing to ensure proper claim submission.
Codes mentioned
812108140381479
Original notice
Medical Policy Update for July 1, 2025
bluecrossnc.com · Always check the source before changing claims.
Related changes
See all Blue Cross NC changes →Medical Policy Update for December 30, 2022HighEffective Jan 1, 2023 · Medical PolicyMedical Policy Update for May 16, 2023HighEffective May 16, 2023 · Medical PolicyMedical Policy Update for December 5, 2023MediumEffective Dec 5, 2023 · Medical PolicyMedical Policy Update for May 15, 2024HighEffective May 15, 2024 · Medical PolicyBrowse every Blue Cross NC change in the policy list