CommercialCoverageHigh impact
2025 September Medical Policy Updates
BlueCross BlueShield of South Carolina·SC · Psychiatry, Dermatology, Plastic Surgery +19 more·Medical Policy
Effective date
Sep 26, 2025
We identified it
Aug 11, 2026
Summary
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 45 medical policy updates effective September 2025, including 2 new policies (Dialectical Behavioral Therapy Programs CAM 395, Light Therapy for Seasonal Affective Disorder CAM 396), 1 major coverage expansion (Renal Denervation CAM 701136 now has positive coverage criteria), and important coding updates (13 new HCPCS codes added to Amniotic Membrane policy CAM 701149). Most updates are routine annual reviews with no coverage intent changes, but several require immediate attention for accurate billing and prior authorization workflows.
Action Required
IMMEDIATE ACTIONS REQUIRED: (1) Billing Team - Update billing software to recognize new HCPCS codes Q4383-Q4397 for amniotic membrane and amniotic fluid injections (CAM 701149) effective immediately. Ensure claims using these codes are not rejected. (2) Prior Authorization Team - Update system to reflect Renal Denervation (CAM 701136) now has POSITIVE coverage criteria (no longer investigational) - adjust PA workflows and remove experimental denials. (3) Clinical Staff - Add Dialectical Behavioral Therapy Programs (CAM 395) and Light Therapy for Seasonal Affective Disorder (CAM 396) as new covered services in provider education materials. (4) All Providers - Note that CAM 041 (Orthognathic Surgery) no longer covers obstructive sleep apnea treatment; reference CAM 701101 instead for OSA-related orthognathic cases. Update encounter forms and clinical documentation requirements accordingly. (5) Cardiology Providers - Note CAM 80157 (Baroreflex Stimulation Devices) no longer covers treatment-resistant hypertension as investigational; heart failure indication remains investigational. Update patient education. Failure to update coding systems will result in claim denials on Q4383-Q4397 codes and inappropriate PA denials on renal denervation cases.