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Blue Cross NCCommercial · Billing Codes · Medical Policy · NC · ENT (Ear, Nose & Throat), Endocrinology, Genetics +1 moreMedium impact

Medical Policy Update for April 1, 2025

Act
by Apr 1, 2025
Effective date
Apr 1, 2025
Identified
Jun 16, 2026

Summary

Blue Cross NC updated multiple genetic testing and specialty procedure policies effective April 1, 2025, adding new CPT codes for genetic testing, removing others, and revising coverage criteria for balloon sinuplasty and continuous glucose monitoring. The changes primarily affect genetic testing billing codes and documentation requirements.

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What to do

by Apr 1, 2025 · 2 steps
01Billing team must update billing software to add new genetic testing codes (0547U, 0548U, 0551U, 0541U, 81437, 81438, 81449, 81456, 81403, 81404, 81405, 81479, 88230, 88248, 88249, 88291) and remove discontinued codes (G0564, G0565, 96040, S0265).
02Update encounter forms and notify providers of revised coverage criteria for genetic testing and balloon sinuplasty procedures.

Codes mentioned

G0564G0565814378143896040S026581449814568140381404814058147988230882488824988291

Original notice

Medical Policy Update for April 1, 2025
bluecrossnc.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross NC changes →
Medical Policy Update for May 15, 2024HighEffective May 15, 2024 · Medical PolicyMedical Policy Update for May 16, 2023HighEffective May 16, 2023 · Medical PolicyMedical Policy Update for December 30, 2022HighEffective Jan 1, 2023 · Medical PolicyMedical Policy Update for February 21, 2024MediumEffective Feb 21, 2024 · Medical PolicyBrowse every Blue Cross NC change in the policy list

Related policy hubs

Blue Cross NC policiesNC policy changesENT (Ear, Nose & Throat)EndocrinologyGeneticsCardiologyCode G0564Code G0565Code 81437Code 81438Code 96040Code S0265Code 81449Code 81456Code 81403Code 81404Code 81405Code 81479Code 88230Code 88248Code 88249Code 88291

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