CommercialBilling CodesMedium impact
Medical Policy Update for July 1, 2025
Blue Cross NC·NC · Gastroenterology, Oncology, Neurology +3 more·Medical Policy
Effective date
Jul 1, 2025
We identified it
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.
Action Required
By July 1, 2025: Billing 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). Remove code 0352U and replace with 0557U for vaginitis testing. Update prior authorization requirements for autism behavioral treatment and genetic counseling requirements for epilepsy testing. Review coverage criteria changes for allergen testing and biomarker testing to ensure proper claim submission.