CommercialCoverageHigh impact
2026 April Medical Policy Updates
BlueCross BlueShield of South Carolina·SC · Orthopedics, Sports Medicine, General Surgery +11 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Aug 11, 2026
Summary
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released April 2026 medical policy updates affecting multiple service lines. Key changes include: archiving 7 outdated policies, adding 6 new consolidated orthopedic arthroplasty/arthroscopy policies, removing investigational status for bioimpedance lymphedema devices, adding new meningococcal vaccine codes with updated benefit limits, and adding prosthetic code L2221. Most updates are annual reviews with no policy intent changes but updated evidence summaries.
Action Required
IMMEDIATE - Effective April 1, 2026: (1) Billing team must add prosthetic code L2221 (Microprocessor-Controlled Prosthetic Lower Limb) to billing system and update fee schedules. (2) Update vaccine coding in system: CPT 90673 now covers ages 9+ (revised benefit limit); add new code CPT 90624 (Meningococcal pentavalent vaccine MB-4C). Verify member age requirements during claim submission. (3) Orthopedic/Surgery staff: Cease billing archived procedures under old policy numbers (CAM 701114, 701117, 701118, 70115, 70178, 70180, 70198, CAM 050). Route hip, knee, and shoulder arthroplasty/arthroscopy claims under new consolidated policies: CAM 771 (Hip Arthroplasty), CAM 772 (Hip Arthroscopy), CAM 773 (Shoulder Arthroplasty), CAM 774 (Shoulder Arthroscopy), CAM 775 (Knee Arthroplasty), CAM 776 (Knee Arthroscopy). (4) Lymphedema providers: Bioimpedance devices (CAM 20182) are NO LONGER investigational—update pre-authorization protocols to approve as medically necessary. (5) Review full policy text on SouthCarolinaBlues.com and BlueChoiceSC.com for each service line. Update internal policy tracking and provider education materials. Failure to use correct policy numbers and codes will result in claim denials and reprocessing delays.