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Blue Cross NCCommercial · Billing Codes · Medical Policy · NC · Orthopedics, Pulmonology, Sleep Medicine +7 moreMedium impact

Medical Policy Update for April 1, 2024

Act
by Apr 1, 2024
Effective date
Apr 1, 2024
Identified
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.

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What to do

by Apr 1, 2024 · 5 steps
01Billing team must update billing system to replace deleted CPT code 97762 with new CPT code 97763 for orthotics.
02Add new HCPCS codes A4438, C1762, C1763, A2026, Q4305-Q4310, and K1037 to system.
03Remove deleted codes 41500, J3490, K1014, and K1022 from encounter forms.
04Update PT/OT billing to limit services to 4 units (one hour) per discipline.
05Verify sleep apnea surgery coverage criteria now requires patients age 18+ and BMI ≤40 for hypoglossal nerve stimulation.

Codes mentioned

9776297763A4438C1762C1763A2026Q4305Q4306Q4307Q4308Q4309Q4310K103741500J3490K1014K1022

Original notice

Medical Policy Update for April 1, 2024
bluecrossnc.com · Always check the source before changing claims.
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Related changes

See all Blue Cross NC changes →
Medical Criteria Update for April 6, 2022MediumEffective Apr 6, 2022 · Medical PolicyMedical Policy Update for May 2, 2023MediumEffective May 2, 2023 · Medical PolicyMedical Policy Update for December 29, 2023HighEffective Jan 1, 2024 · Medical PolicyMedical Policy Update for September 18, 2024MediumEffective Sep 18, 2024 · Medical PolicyBrowse every Blue Cross NC change in the policy list

Related policy hubs

Blue Cross NC policiesNC policy changesOrthopedicsPulmonologySleep MedicinePlastic SurgeryPhysical TherapyOccupational TherapyPain ManagementOB-GYNUrologyENT (Ear, Nose & Throat)Code 97762Code 97763Code A4438Code C1762Code C1763Code A2026Code Q4305Code Q4306Code Q4307Code Q4308Code Q4309Code Q4310Code K1037Code 41500Code J3490Code K1014Code K1022

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