CommercialCoverageHigh impact
Medical Policy Update for October 30, 2024
Blue Cross NC·NC · Cardiology, Internal Medicine, Family Medicine +3 more·Medical Policy
Effective date
Oct 24, 2023
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield of North Carolina updated multiple medical policies effective October 24, 2023, including significant changes to cardiac biomarker testing, genetic testing coverage criteria, and vector-borne infection testing protocols. Most notably, cardiac troponin testing is now limited to 4 times within 72 hours and qualitative troponin testing is no longer covered.
Action Required
Immediately: Update billing system to limit cardiac troponin testing (troponin T or I) to maximum 4 quantitative tests within 72 hours for acute coronary syndrome patients. Stop billing for qualitative troponin testing and ST2 analysis (e.g., Presage ST2) in outpatient settings - these will be denied. Update encounter forms to include new CPT codes 83006, 84702, 84703, 84704, 0167U, 85060, 87254, and 87798. Change billing software language from 'Reimbursement' to 'Medical Necessity' for all genetic testing policies. Verify ESR testing is only billed for patients with diagnosed inflammatory conditions.