CommercialCoverageHigh impact
Medical Policy Update for November 15, 2022
Blue Cross NC·NC · Plastic Surgery, Psychiatry, Oncology +3 more·Medical Policy
Effective date
Nov 15, 2022
We identified it
Jun 16, 2026
Summary
BCBSNC updated multiple medical policies effective November 15, 2022, including new coverage criteria for autism treatment, breast implant removal procedures, coronavirus testing, and genetic testing for mental health. Gender affirmation surgery codes 15876 and 15877 moved from non-covered to covered status.
Action Required
Immediately: Update billing system to reflect CPT codes 15876 and 15877 are now covered for gender affirmation surgery. Add codes 19370 and 19371 for breast implant removal procedures with specific coverage criteria based on Baker Classification System. Review autism spectrum disorder claims to ensure DSM-5 diagnosis by qualified specialists. Update prior authorization workflows for new coronavirus testing policy and mark genetic testing for mental health disorders as investigational/non-covered.