CommercialCoverageMedium impact
Medical Policy Update for February 21, 2023
Blue Cross NC·NC · Neurology, Pediatrics, Family Medicine +1 more·Medical Policy
Effective date
Feb 21, 2023
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated genetic testing policies for muscular dystrophies and neurofibromatosis disorders, adding new CPT code 81407 for muscular dystrophy testing and revising coverage criteria for both conditions. The changes clarify when genetic testing is medically necessary and update clinical requirements.
Action Required
Immediately: Update billing system to include CPT code 81407 for genetic testing of muscular dystrophies. Review and update prior authorization requests for genetic testing of muscular dystrophies and neurofibromatosis to align with revised coverage criteria - ensure documentation supports medical necessity under new guidelines. Train billing staff on updated coverage requirements.