CommercialCoverageMedium impact
Medical Policy Update for July 26, 2022
Blue Cross NC·NC · Ophthalmology, Orthopedics, Gastroenterology +3 more·Medical Policy
Effective date
Jul 26, 2022
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated 28 medical policies effective July 26, 2022, with key changes including new non-coverage for BRCA genetic testing in minors under 18, restrictions on immunopharmacologic monitoring for anti-TNF therapies in certain conditions, expanded coverage criteria for magnetic esophageal sphincter augmentation, and removal/addition of various CPT codes across multiple specialties.
Action Required
By July 26, 2022: Billing teams must update systems to reflect code changes - stop using expired codes 0396T and L8698, replace 0190T with 67299 for epiretinal radiation therapy. Update prior authorization requirements for BRCA testing to exclude minors under 18. Review and update billing guidelines for anti-TNF therapy monitoring and magnetic esophageal sphincter augmentation procedures based on new coverage criteria.