CommercialBilling CodesMedium impact
Medical Policy Update for April 1, 2024
Blue Cross NC·NC · Orthopedics, Pulmonology, Sleep Medicine +7 more·Medical Policy
Effective date
Apr 1, 2024
We identified it
Jun 16, 2026
Summary
BCBS North Carolina updated multiple medical policies effective April 1, 2024, including new billing code additions, code deletions, and coverage criteria changes. Key changes include new HCPCS codes for skin substitutes and sleep apnea devices, deletion of orthotic and surgical codes, and updated coverage criteria for sleep apnea surgery.
Action Required
By April 1, 2024: Billing team must update billing system to replace deleted CPT code 97762 with new CPT code 97763 for orthotics. Add new HCPCS codes A4438, C1762, C1763, A2026, Q4305-Q4310, and K1037 to system. Remove deleted codes 41500, J3490, K1014, and K1022 from encounter forms. Update PT/OT billing to limit services to 4 units (one hour) per discipline. Verify sleep apnea surgery coverage criteria now requires patients age 18+ and BMI ≤40 for hypoglossal nerve stimulation.