CommercialCoverageHigh impact
Medical Policy Update for March 12, 2025
Blue Cross NC·NC · Psychiatry, ENT (Ear, Nose & Throat), Neurology +5 more·Medical Policy
Effective date
Mar 12, 2025
We identified it
Jun 16, 2026
Summary
This is a comprehensive medical policy update affecting multiple specialties with coverage changes, documentation requirements, and age restrictions across 31 different medical policies. Key changes include new coverage restrictions for telehealth partial hospitalization programs, age requirement updates for hearing aids and psychiatric treatments, and added investigational status for outpatient intravenous insulin therapy.
Action Required
By March 12, 2025: Billing teams must update systems to reflect multiple policy changes including: 1) Stop billing telehealth services for partial hospitalization programs (both psychiatric and substance use disorder), 2) Remove 12-year age requirement for Osia hearing aid system claims, 3) Update age eligibility for repeat transcranial magnetic stimulation from 18+ to 15+ years, 4) Flag outpatient intravenous insulin therapy as investigational/non-covered under complementary medicine policies. Update encounter forms and prior authorization workflows accordingly.