2025 February Medical Policy Updates

IMMEDIATE ACTIONS (By 02/27/2025): (1) Bariatric Surgery Program: Stop covering routine esophagogastroduodenoscopy with bariatric surgery procedures. Update billing system to deny or require prior authorization challenge for any claims bundling esophagogastroduodenoscopy with bariatric procedures. Notify bariatric surgery providers of coverage restriction. (2) Developmental Delay Testing: Restrict genetic testing coverage to ONLY chromosomal microarray, whole exome sequencing, whole genome sequencing, fragile X syndrome testing, or Rett syndrome testing. Update billing system coverage rules and encounter forms. Deny all other developmental delay genetic testing (e.g., targeted panels, single-gene testing). (3) Biofeedback Coding: Add HCPCS code S9002 to billing system for CAM 20127 (Biofeedback as Treatment of Urinary Incontinence). BEFORE 04/01/2025: Billing team must update billing software to recognize and process new genetic/pathology codes (0202U, 0223U, 0225U, 0539U, 0540U, 0544U, 0310U, 0535U, 0537U, 0542U, 0545U, 0546U, 0533U) with 04/01/2025 effective date. Test claims with these codes for proper bundling and reimbursement before April 1. ONGOING: Continue reviewing https://www.SouthCarolinaBlues.com and https://www.BlueChoiceSC.com for full policy text and future updates. Consequences: Claims billed without adhering to new coverage restrictions will be denied. Failure to implement code changes by 04/01/2025 will result in claim rejections.