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Blue Cross NCCommercial · Billing Codes · Medical Policy · NC · Cardiology, Cardiothoracic Surgery, Endocrinology +8 moreHigh impact

Medical Policy Update July 15, 2026

Act
by Jul 15, 2026
Effective date
Jul 15, 2026
Identified
Jul 15, 2026

Summary

Blue Cross NC released a comprehensive medical policy update effective July 15, 2026, affecting 30+ clinical policies across cardiology, endocrinology, ophthalmology, orthopedics, and other specialties. Key changes include: removal of specific billing codes (99091, 98925-98929), expansion of coverage for artificial pancreas devices in type 2 diabetes, archival of three policies (Fundus Photography, Refractive Surgery, Sensory Integration Therapy), and clarification edits to multiple cardiac and ophthalmic procedures. Billing teams must identify affected services within their patient populations and update claims processing logic accordingly.

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What to do

by Jul 15, 2026 · 6 steps
01Billing team must remove CPT codes 99091, 98925, 98926, 98927, 98928, and 98929 from all billing system claim submission rules and encounter templates.
02Do not bill these codes for commercial Blue Cross NC claims effective on or after this date.
03Update claim scrubbing logic to reject or flag any claims containing these codes for manual review and rebilling with appropriate alternatives.
04Providers must verify benefit coverage for artificial pancreas device systems (hybrid closed-loop insulin delivery) in type 2 diabetes patients, as this now has positive coverage criteria.
05For archived policies (Fundus Photography, Refractive Surgery, Sensory Integration Therapy/Auditory Integration Therapy), cease billing these services under Blue Cross NC commercial plans unless alternative coverage can be identified.
06Clinical staff should review updated policy guidelines for cardiac procedures (CAS, cardiac transplant, ICD, LVAD, transcatheter valve procedures, LAA closure), ophthalmic procedures (glaucoma imaging, keratoprosthesis, dry eye thermal pulsation), and orthopedic procedures (computer-assisted navigation, patient-specific instrumentation, bone growth stimulation) to ensure prior authorization requests align with revised 'When Covered' criteria.
If missed: Failure to implement code removals will result in claim denials and recoupment.

Codes mentioned

990919892598926989279892898929

Original notice

Medical Policy Update July 15, 2026
bluecrossnc.com · Always check the source before changing claims.
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Related changes

See all Blue Cross NC changes →
Medical Policy Update July 15, 2026LowNo effective date · Medical PolicyMedical Policy Update July 1, 2026HighEffective Jul 1, 2026 · Medical PolicyMedical Policy Update for June 14, 2022MediumEffective Jul 1, 2022 · Medical PolicyMedical Policy Update for December 30, 2022HighEffective Jan 1, 2023 · Medical PolicyBrowse every Blue Cross NC change in the policy list

Related policy hubs

Blue Cross NC policiesNC policy changesCardiologyCardiothoracic SurgeryEndocrinologyOphthalmologyOrthopedicsSports MedicineNeurologyGeneral SurgeryVascular SurgeryPsychiatryAudiologyCode 99091Code 98925Code 98926Code 98927Code 98928Code 98929

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