CommercialBilling CodesHigh impact
Medical Policy Update July 15, 2026
Blue Cross NC·NC · Cardiology, Cardiothoracic Surgery, Endocrinology +8 more·Medical Policy
Effective date
Jul 15, 2026
We identified it
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.
Action Required
By July 15, 2026: (1) Billing team must remove CPT codes 99091, 98925, 98926, 98927, 98928, and 98929 from all billing system claim submission rules and encounter templates. Do not bill these codes for commercial Blue Cross NC claims effective on or after this date. (2) Update claim scrubbing logic to reject or flag any claims containing these codes for manual review and rebilling with appropriate alternatives. (3) Providers 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. (4) For 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. (5) Clinical 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. Failure to implement code removals will result in claim denials and recoupment.