When does this change take effect?

This change is effective May 15, 2024.

What do I need to do?

By May 15, 2024: Billing team must update billing software to reflect new CPT codes for biomarker testing (86200, 86430, 86431), liquid biopsy (0388U, 0395U), myeloproliferative neoplasm testing (multiple genetic codes), and pre-implantation genetic testing. Remove discontinued codes including 84999 and 81350. Update prior authorization requirements for rheumatoid factor and anti-CCP testing to once per lifetime unless significant symptom changes occur. Verify nucleic acid amplification testing coverage for failed onychomycosis treatments. Claims using old codes or not meeting new criteria will be denied.

← Back to list

Blue Cross NCCommercial · Billing Codes · Medical Policy · NC · Rheumatology, Oncology, Hematology +7 moreHigh impact

Medical Policy Update for May 15, 2024

Q: Who is affected by this change?

This affects Blue Cross NC Rheumatology, Oncology, Hematology, Allergy & Immunology, Infectious Disease, Gastroenterology +4 more providers in NC on Commercial plans.

Q: Which billing codes are affected?

The following codes are affected: 86200, 86430, 86431, 81206, 81207, 81208, 81273, 81275, 81276, 81311, 81347, 81351, 81352, 81353, 81357, 81403, 81405, 81432, 81442, 81228, 81229, 81349, 81479, 96040, S0265, 81251, 81255, 81257, 81260, 81290, 81326, 81330, 81331, 81332, 81413, 81414, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88271, 88272, 88273, 82274, 88275, 81161, 81200, 81201, 81202, 81203, 81205, 81209, 81220, 81221, 81240, 81242, 81243, 81244, 81250, 81252, 81253, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81303, 81304, 81310, 81321, 81322, 81323, 81324, 81325, 84999, 81350.

Act

by May 15, 2024

Effective date

May 15, 2024

Identified

Jun 16, 2026

Summary

Blue Cross NC updated 24 medical policies effective May 15, 2024, with multiple changes to coverage criteria, billing codes, and documentation requirements across various specialties including rheumatology, oncology, genetic testing, and infectious disease testing.

Get alerts when payers change rules like this one

We check Blue Cross NC and other payers every day and email you when a change matches your specialty and state.

Get Blue Cross NC alertsPolicy Monitoring is free. No card required.

What to do

by May 15, 2024 · 5 steps

01Billing team must update billing software to reflect new CPT codes for biomarker testing (86200, 86430, 86431), liquid biopsy (0388U, 0395U), myeloproliferative neoplasm testing (multiple genetic codes), and pre-implantation genetic testing.

02Remove discontinued codes including 84999 and 81350.

03Update prior authorization requirements for rheumatoid factor and anti-CCP testing to once per lifetime unless significant symptom changes occur.

04Verify nucleic acid amplification testing coverage for failed onychomycosis treatments.

05Claims using old codes or not meeting new criteria will be denied.

Codes mentioned

862008643086431812068120781208812738127581276813118134781351813528135381357814038140581432814428122881229813498147996040S0265812518125581257812608129081326813308133181332814138141488245882488824988261882628826388264882718827288273822748827581161812008120181202812038120581209812208122181240812428124381244812508125281253812888129281293812948129581296812978129881299813008130181303813048131081321813228132381324813258499981350

Original notice

Medical Policy Update for May 15, 2024

bluecrossnc.com · Always check the source before changing claims.

View original ↗

Related changes

See all Blue Cross NC changes →

Medical Policy Update for April 1, 2025MediumEffective Apr 1, 2025 · Medical Policy Medical Policy Update for May 16, 2023HighEffective May 16, 2023 · Medical Policy Medical Policy Update for December 5, 2023MediumEffective Dec 5, 2023 · Medical Policy Medical Policy Update for February 21, 2024MediumEffective Feb 21, 2024 · Medical Policy Browse every Blue Cross NC change in the policy list

Related policy hubs

Blue Cross NC policies NC policy changes Rheumatology Oncology Hematology Allergy & Immunology Infectious Disease Gastroenterology Urology Dermatology Endocrinology OB-GYN Code 86200 Code 86430 Code 86431 Code 81206 Code 81207 Code 81208 Code 81273 Code 81275 Code 81276 Code 81311 Code 81347 Code 81351 Code 81352 Code 81353 Code 81357 Code 81403 Code 81405 Code 81432 Code 81442 Code 81228 Code 81229 Code 81349 Code 81479 Code 96040 Code S0265 Code 81251 Code 81255 Code 81257 Code 81260 Code 81290 Code 81326 Code 81330 Code 81331 Code 81332 Code 81413 Code 81414 Code 88245 Code 88248 Code 88249 Code 88261 Code 88262 Code 88263 Code 88264 Code 88271 Code 88272 Code 88273 Code 82274 Code 88275 Code 81161 Code 81200 Code 81201 Code 81202 Code 81203 Code 81205 Code 81209 Code 81220 Code 81221 Code 81240 Code 81242 Code 81243 Code 81244 Code 81250 Code 81252 Code 81253 Code 81288 Code 81292 Code 81293 Code 81294 Code 81295 Code 81296 Code 81297 Code 81298 Code 81299 Code 81300 Code 81301 Code 81303 Code 81304 Code 81310 Code 81321 Code 81322 Code 81323 Code 81324 Code 81325 Code 84999 Code 81350

Medical Policy Update for May 15, 2024

Summary

Get alerts when payers change rules like this one

What to do

Codes mentioned

Original notice

Related changes

Related policy hubs

One workspace for payer rules, prior auth, coding and compliance