Summary
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan updated 44 medical policies in September 2026, with most changes involving clarifications and reference updates. Eight policies include new CPT codes effective 10/01/2026 (0665U, 0691U, 0686U, 0662U–0685U, 0687U, 0695U, 0678U), and three orthopedic/spine policies (CAM 399, CAM 400, CAM 774) now require negative nicotine lab tests for smokers and restrict coverage for patients with elevated blood sugar prior to spine/shoulder surgery approval.
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What to do
Action · 4 steps
01Previously due 10/01/2026 (date passed; verify current applicability): Billing team must update billing software to add the following new CPT codes to the respective policies: 0665U (CAM 332), 0691U (CAM 398), 0686U (CAM 241), 0662U–0685U and 0687U and 0695U (CAM 235), and 0678U (CAM 168).
02Remove CPT codes 0539U and 0577U from CAM 273.
03For spine and shoulder surgery policies (CAM 399, CAM 400, CAM 774), billing and prior authorization teams must implement new clinical requirements: (1) verification of negative nicotine lab test for any patient with smoking history prior to spine surgery approval, and (2) documentation that blood sugar is not elevated before approving deformity spine surgery, thoracic spine surgery, or shoulder arthroscopy procedures.
04Update pre-authorization workflows and clinical review templates to flag cases requiring these labs.
If missed: Failure to implement code changes will result in claim denials for services billed with unrecognized codes effective 10/01/2026.
Original notice
2026 September Medical Policy Updates
southcarolinablues.com · Always check the source before changing claims.