CommercialCoverageMedium impact
Medical Policy Update for July 31, 2024
Blue Cross NC·NC · Oncology, Gastroenterology, Pathology·Medical Policy
Effective date
Jul 31, 2024
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated medical policies effective July 31, 2024, with key changes to esophageal pathology testing criteria including reorganized coverage requirements for cancer diagnosis and treatment planning, restrictions on certain genetic tests, and new billing codes added for skilled nursing services.
Action Required
By July 31, 2024: Billing team must update systems to remove code 0386U from esophageal pathology testing claims and add new HCPCS codes G0320, G0321, G0490, S9563, and S9590 for skilled nursing services. Providers must review updated criteria for esophageal pathology testing coverage, including new restrictions on WATS testing and molecular classifiers like BarreGEN and EsoGuard which are now considered not medically necessary.