2025 August Medical Policy Updates

DEADLINE: By September 15, 2025, complete the following tasks: (1) BILLING TEAM - Update billing software to ADD CPT 81479, 81403, 81415, 81416, 81417, 81425, 81426, and HCPCS G0567 to covered code lists. (2) BILLING TEAM - Remove from covered codes: CPT 83615, 81252, 81254, 96040, S0265, S3844, and 0209U. (3) BILLING TEAM - Configure billing system to allow CPT 81403 and 81479 for genetic testing for hereditary hearing loss (CAM 294) with repeat testing coverage. (4) CLINICAL STAFF - Update encounter forms and EMR templates for CAM 127 (Hepatitis Testing) to capture patients on immunosuppressant therapy as newly covered; update testing frequency documentation to reflect once every three months allowed per coverage criteria 8. (5) BILLING TEAM - Review CAM 320 (Familial Hypercholesterolemia) complete policy rewrite and update order entry/billing rules to reflect new clinical suspicion criteria for genetic testing and new coverage criteria 2 for individuals with prior negative variant testing. (6) PROVIDERS - Reference updated CAM 342 (Microsatellite Instability/Tumor Mutational Burden Testing) which now includes expanded solid tumor indications (neuroendocrine/adrenal cancers, prostate cancers, uterine cancers, bladder cancer, CNS cancer, vaginal cancer) per NCCN guidelines - update oncology/pathology ordering practices. CONSEQUENCES: Failure to update codes will result in claim denials for newly covered services (G0567, 81479, etc.) and incorrect denials for codes that should no longer be billed.