CommercialBilling CodesHigh impact
2025 October Medical Policy Updates
BlueCross BlueShield of South Carolina·SC · Neurosurgery, Orthopedics, Oncology +16 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Aug 11, 2026
Summary
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released comprehensive October 2025 medical policy updates affecting 50+ policies, including three new spine surgery policies (CAM 401, CAM 400, CAM 399), addition of multiple new billing codes for genetic testing and diagnostic services effective 10/01/2025, and annual reviews with updated evidence/references for existing policies. Most changes involve CPT/HCPCS code additions and clarification updates with no change to coverage intent, but three new spine surgery policies require immediate review for coverage determination criteria.
Action Required
IMMEDIATE: Billing team must review and implement the three new spine surgery policies (CAM 401 Spine Surgery Other, CAM 400 Thoracic Spine Surgery, CAM 399 Deformity Surgery) to understand coverage criteria before processing claims. By October 1, 2025: Update billing software to recognize and properly bill new codes E0659, 0590U, 0593U, 0597U, 0591U, 0578U, 0577U, 0598U, 0592U, and 83884. Remove deleted codes 87040, 0500T, 81376, 81377, 81382, 81383, 88341, and 88342 from billing templates and superbills. For immunization codes 90679, 90683, 90678, verify age limit changes (now 75 years and older) and add CPT 90382 for neonates. Review CAM 181 for expanded pathogen panel coverage (up to 25 respiratory pathogens for immunocompromised members). Update encounter forms and clinical documentation templates. Verify with BlueChoice plans regarding CAM 318 fecal calprotectin testing addition and CAM 332 coverage expansion for ELF and Fibro Test. Providers must document medical necessity per updated policy intent. Failure to implement code changes will result in claim denials or delays.