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Medical Policy Update for October 24, 2023
Blue Cross NC·NC · Cardiology, Family Medicine, Internal Medicine +3 more·Medical Policy
Effective date
Oct 24, 2023
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated multiple medical policies effective October 24, 2023, with significant changes to cardiac biomarker testing, genetic testing terminology, inflammation testing restrictions, prenatal screening limitations, and vector-borne infection testing coverage. Key changes include new limitations on troponin testing (max 4 times in 72 hours), prohibition of qualitative troponin tests, restrictions on ESR testing without diagnosed inflammatory conditions, and expanded Zika/dengue virus testing criteria.
Action Required
Immediately: Update billing systems to limit cardiac troponin testing to maximum 4 times within 72 hours for acute coronary syndrome patients. Stop billing qualitative troponin tests (will be denied). Restrict ESR testing billing to patients with diagnosed inflammatory conditions only. Update prior authorization requirements for genetic testing policies that changed from 'reimbursement' to 'medical necessity' language. Add new CPT codes 83006, 84702, 84703, 84704, 0167U, 85060, 87254, 87798 to billing systems. Train staff on new Zika/dengue testing criteria for pregnant patients.