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BlueCross BlueShield of South CarolinaAll Plans · Billing Codes · Medical Policy · SC · Pain Management, Oral & Maxillofacial Surgery, Sleep Medicine +1 moreMedium impact

2025 September Medical Policy Updates

Effective date
Not stated in the notice
Identified
Aug 11, 2026

Summary

Amniotic Membrane and Amniotic Fluid Injections for Non-Ophthalmic Applications (CAM 701149) adds HCPCS codes Q4383, Q4384, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396 and Q4397. Renal Denervation for Uncontrolled Hypertension (CAM 701136) adds positive coverage criteria for renal denervation for uncontrolled hypertension, and Baroreflex Stimulation Devices (CAM 80157) removes the investigational indication for treatment resistant hypertension while keeping the investigational indication for heart failure. Orthognathic Surgery (CAM 041) removes treatment of obstructive sleep apnea and adds it to CAM 701101, and Temporomandibular Joint Dysfunction (CAM 20121) adds botulinum toxin A to non-surgical investigational treatment.

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What to do

Action · 3 steps
01Use HCPCS Q4383, Q4384, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396 and Q4397 for amniotic membrane and amniotic fluid injections for non-ophthalmic applications, because the updated coding section adds them.
02Treatment of obstructive sleep apnea is removed from the orthognathic surgery policy (CAM 041) and added to CAM 701101, and the diagnosis codes for obstructive sleep apnea are removed from CAM 041.
03Baroreflex stimulation devices are no longer investigational for treatment resistant hypertension, and they remain investigational for heart failure.

Codes mentioned

Q4383Q4384Q4386Q4387Q4388Q4389Q4390Q4391Q4392Q4393Q4394Q4395Q4396Q4397

Original notice

2025 September Medical Policy Updates
southcarolinablues.com · Always check the source before changing claims.
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Related changes

See all BlueCross BlueShield of South Carolina changes →
2026 July Medical Policy UpdatesHighEffective Jul 1, 2026 · Medical Policy2025 January Medical Policy UpdatesLowEffective Jan 1, 2025 · Medical Policy2025 March Medical Policy UpdatesMediumEffective Apr 1, 2025 · Medical Policy2025 July Medical Policy UpdatesMediumEffective Jul 29, 2025 · Medical PolicyBrowse every BlueCross BlueShield of South Carolina change in the policy list

Related policy hubs

BlueCross BlueShield of South Carolina policiesSC policy changesPain ManagementOral & Maxillofacial SurgerySleep MedicineCardiologyCode Q4383Code Q4384Code Q4386Code Q4387Code Q4388Code Q4389Code Q4390Code Q4391Code Q4392Code Q4393Code Q4394Code Q4395Code Q4396Code Q4397

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