CommercialCoverageMedium impact
Medical Policy Update for February 12, 2025
Blue Cross NC·NC · Family Medicine, Internal Medicine, Infectious Disease +2 more·Medical Policy
Effective date
Feb 12, 2025
We identified it
Jun 16, 2026
Summary
Blue Cross North Carolina updated 12 medical policies effective February 12, 2025, with changes to coverage criteria, billing codes, and testing requirements across multiple diagnostic areas including strep testing, cardiovascular risk assessment, STI testing, hepatitis testing, and pathogen panels.
Action Required
By February 12, 2025: Billing team must update system to add new CPT codes 86581, 84512, 86692, 96708, 96709, 97380, 87516, 87523, 87799, and 0528U effective 1/1/25. Remove CPT codes 96040, S0265, and 87563 from billing. Update PLA code from 0167U to 0484U for STI testing. Review coverage criteria changes for cardiovascular screening (now every 4 years ages 18-79), pathogen panel testing frequency limits, and hepatitis C screening age changes.