CommercialBilling CodesHigh impact
Medical Policy Update for December 31, 2024
Blue Cross NC·NC · Cardiology, Neurology, Pain Management +10 more·Medical Policy
Effective date
Jan 1, 2025
We identified it
Jun 16, 2026
Summary
This is a comprehensive policy update affecting multiple medical services with numerous new CPT/HCPCS codes being added and some deleted effective January 1, 2025. Key changes include new coverage for facility-based crisis services and penile prosthesis, updated billing codes for cardiac monitoring, genetic testing, wound care, and pain management procedures.
Action Required
By January 1, 2025: Billing team must update billing software and fee schedules to include all new CPT/HCPCS codes and remove deleted codes (81433, 81436, 96040, 0428U, 0448U, 0398T, G2070-G2072, H0010). Update encounter forms and EMR templates to reflect new coverage criteria for facility-based crisis services, penile prosthesis, and updated trigger point injection requirements. Verify billing system can handle the extensive list of new orthotics codes (E1803-E1829) and skin substitute codes (Q4346-Q4353). Claims submitted with outdated codes will be denied.