| Medical Policy |
Revision |
| Adaptive Behavioral Treatment for Autism Spectrum Disorders "Notification" |
Added the following statement to When Covered Section: “There is an established DSM-5 diagnosis of Autism Spectrum Disorder diagnosed by a psychiatrist, psychologist, neurologist, developmental pediatrician, or other licensed physician experienced in the diagnosis and treatment of autism. Medical Director review 8/2022. Notification given 9/13/2022 for effective date 11/15/2022. |
| Breast Surgeries "Notification" |
Section V Surgical Management of Breast Implants description updated. Section V When Covered section updated to include the following statement: “Removal of breast implants with capsulectomy/capsulotomy is considered medically necessary when the following criteria has been met (See Policy Guidelines): Baker Class III contractures (only if the initial implant was for reconstructive purposes), Baker Class IV contracture.” And “Removal of a breast implant and capsulectomy is covered, regardless of the indication for the initial implant placement, for: Treatment of Anaplastic Lymphoma of the breast when there is pathologic confirmation of the diagnosis by cytology or biopsy; or Individuals with an increased risk of implant-associated Anaplastic Lymphoma of the breast due to use of Allergan BIOCELL textured breast implants and tissue expanders.” Section V When not Covered section updated to include the following statement: “Removal of breast implants with capsulectomy/capsulotomy is not covered for Baker Class III contractures in patients with implants for cosmetic purposes.” Section V Policy Guidelines Updated to include Baker Classification System. Added codes 19370 and 19371 to Section V Billing/Coding Section, References updated. Medical Director Review 8/2022. Specialty Matched Consultant Advisory Panel review 8/2022. Notification given 9/13/2022 for effective date 11/15/2022. |
| Coronavirus Testing in the Outpatient Setting AHS-G2174 "Notification" |
New policy developed. BCBSNC will provide coverage for Coronavirus Testing in the Outpatient Setting when medical criteria and guidelines outlined in the policy are met. Medical Director review 7/2022. Notification give 9/13/2022 for effective date 11/15/2022. |
| Genetic Testing for Mental Health Disorders M2084 "Notification" |
New policy developed. Genetic Testing for Mental Health Disorders is considered investigational for all applications. BCBSNC does not provide coverage for investigational services or procedures. Medical Director review 7/2022. Notification given 9/13/2022 for effective date 11/15/2022. |
Blue Connect