2025 April Medical Policy Updates

IMMEDIATE (effective April 25, 2025): 1) Billing team must stop reimbursing physical therapy, occupational therapy, and speech therapy telehealth services under policy CAM 176. Remove these clinicians from approved telehealth provider lists in billing system and deny all telehealth claims for these specialties going forward. 2) Update claim denial protocols for policy CAM 253 to automatically deny suction-assisted lipectomy claims (new codes 15834, 15835) and skin excision adjunct claims (code 18538) as cosmetic/not medically necessary. 3) Coding staff must add new CPT code 0573U (Guardant Shield test) to colorectal cancer screening criteria #4 under policy CAM 384. 4) Update H. pylori testing coverage (CAM 271) to only reimburse urea breath testing or stool antigen testing performed at least 4 weeks post-treatment for eradication confirmation. 5) Providers must document specific imaging criteria from updated AUC scoring guidance for coronary CTA (CAM 765). 6) Oncology and neurosurgery teams should enable new coverage for laser interstitial thermal therapy (CAM 701170) for epilepsy, brain tumors, and radiation necrosis claims—these are no longer investigational. Review full policy text on SouthCarolinaBlues.com and BlueChoiceSC.com. Failure to implement telehealth denials and cosmetic lipectomy denials will result in improper reimbursement.