CommercialBilling CodesMedium impact
2025 August Medical Policy Updates
BlueCross BlueShield of South Carolina·SC · Genetics, Oncology, Hematology +15 more·Medical Policy
Effective date
Aug 28, 2025
We identified it
Aug 11, 2026
Summary
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released August 2025 medical policy updates affecting 48 policies. Most are annual reviews with no coverage intent changes but updated evidence, references, and rationale. Key changes include: two hematopoietic cell transplant policies archived; hepatitis testing expanded to immunosuppressed patients with new HCPCS code G0567; serum tumor markers coverage criteria broadened; familial hypercholesterolemia testing completely rewritten with new clinical suspicion definitions; and multiple genetic testing policies updated with new CPT codes and expanded repeat testing criteria.
Action Required
By September 28, 2025: Billing and clinical teams must take the following actions: (1) Update billing system to add HCPCS code G0567 for hepatitis testing and remove CPT 83615 from serum tumor marker billing. (2) Remove outdated genetic testing codes (96040, S0265, 81252, 81254, S3844, 81599, 0209U) from billing templates and system rules. (3) Add new genetic testing CPT codes (81479, 81403, 81415, 81416, 81417, 81425, 81426) to billing system with appropriate policy indicators. (4) For CAM 127 (Hepatitis Testing): Update coverage criteria to include patients on immunosuppressant therapy; change frequency limits for criteria 8 to once every three months. (5) For CAM 320 (Familial Hypercholesterolemia): Implement new clinical suspicion criteria for coverage determination; train providers on new requirements for patients with suspected FH and those with prior negative variant testing. (6) For CAM 277 (Serum Tumor Markers): Expand coverage criteria 1 definitions per broadened table. (7) For genetic testing policies (CAM 294, CAM 311, CAM 342): Update repeat testing authorizations and tumor indication tables to match NCCN guidelines (includes bladder, CNS, vaginal, neuroendocrine/adrenal, prostate, and uterine cancers). (8) Archive policies CAM 80154 and CAM 80122—remove from active billing rules and stop accepting claims under these policies. Failure to implement code changes will result in claim denials; failure to update coverage criteria will cause inappropriate approvals/denials.