CommercialCoverageHigh impact
2026 April Medical Policy Updates
BlueCross BlueShield of South Carolina·SC · Orthopedics, Allergy & Immunology, General Surgery +9 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Aug 20, 2026
Summary
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released April 2026 medical policy updates affecting multiple clinical areas. Key changes include: archival of 6 orthopedic policies (reverse shoulder arthroplasty, knee arthroscopy/debridement, hip resurfacing, meniscal allografts, cartilage treatments, minimally invasive hip/knee procedures) with coverage now consolidated into 6 new unified arthroplasty/arthroscopy policies (CAM 771-776); addition of new vaccine code CPT 90624 with updated age parameters for CPT 90673; removal of investigational status for bioimpedance lymphedema devices (CAM 20182); and addition of prosthetic code L2221. Most updates are annual reviews with no coverage intent changes, but require system and documentation updates.
Action Required
By April 1, 2026: (1) Billing Team - Update billing system to remove 6 archived orthopedic policies (CAM 701114, 701117, 701118, 70115, 70178, 70180, 70198) from active coverage lookup tables. (2) Billing Team - Add new orthopedic policies CAM 771 (Hip Arthroplasty), CAM 772 (Hip Arthroscopy), CAM 773 (Shoulder Arthroplasty), CAM 774 (Shoulder Arthroscopy), CAM 775 (Knee Arthroplasty), CAM 776 (Knee Arthroscopy) to system with appropriate prior authorization requirements. (3) Billing Team - Update immunization billing logic to accept CPT 90624 (new meningococcal vaccine) and modify CPT 90673 benefit limits to age 9 years and older (update any age 11+ or other age-based edits). (4) Billing Team - Add prosthetic code L2221 to CPT/HCPCS crosswalk for microprocessor-controlled lower limb prosthetics effective 04/01/2026. (5) Clinical/Documentation Staff - Update encounter templates and care protocols to reflect bioimpedance devices (CAM 20182) as medically necessary (not investigational) for lymphedema diagnosis codes. (6) All Staff - Review full policy text at www.SouthCarolinaBlues.com and www.BlueChoiceSC.com for updated evidence summaries, rationale, and coding guidance on affected policies. Failure to update billing rules will result in claim denials for archived procedures and rejection of new vaccine/prosthetic codes.