Medical policy updates
Read about the latest medical policy changes for 2024. You can also see medical policy changes for 2023.
New and updated policies effective November 1, 2024
|
Policy Title |
Policy# |
Status |
---|---|---|---|
1 |
Bariatric Surgery |
7.01.47 |
|
2 |
Ablation of Peripheral Nerves to Treat Pain |
7.01.154 |
Minor Update |
3 |
Amniotic Membrane and Amniotic Fluid |
7.01.149 |
Admin Update |
4 |
Aqueous Shunts and Stents for Glaucoma |
9.03.21 |
Minor Update |
5 |
Balloon Dilation of the Eustachian Tube |
7.01.158 |
Minor Update |
6 |
Bioengineered Skin and Soft Tissue Substitutes |
7.01.113 |
Admin Update |
7 |
Biofeedback for Miscellaneous Indications |
2.01.53 |
Admin Update |
8 |
Bone Mineral Density Studies |
6.01.01 |
Minor Update |
9 |
Cardiac Applications of Positron Emission Tomography Scanning |
6.01.20 |
Minor Update |
10 |
Computed Tomography Perfusion Imaging of the Brain |
6.01.49 |
Minor Update |
11 |
Cranial Electrotherapy Stimulation and Auricular Electrostimulation |
8.01.58 |
Admin Update |
12 |
Cryosurgical Ablation of Primary or Metastatic Liver Tumors |
7.01.75 |
Minor Update |
13 |
Drug Testing in Pain Management and Substance Use Disorder Treatment |
2.04.98 |
Admin Update |
14 |
Dynamic Spinal Visualization and Vertebral Motion Analysis |
6.01.46 |
Minor Update |
15 |
Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer |
6.01.58 |
Minor Update |
16 |
Focal Treatments for Prostate Cancer |
8.01.61 |
Minor Update |
17 |
Functional Magnetic Resonance Imaging of the Brain |
|
Minor Update |
18 |
Genetic Testing: Kidney Disorders |
BSC_CON_2.22 |
Admin Update |
19 |
Genetic Testing: Pharmacogenetics |
BSC_CON_2.12 |
Admin Update |
20 |
Genetic Testing: Preimplantation Genetic Testing |
BSC_CON_2.03 |
Admin Update |
21 |
Hyperbaric Oxygen Therapy |
2.01.04 |
Minor Update |
22 |
Identification of Microorganisms Using Nucleic Acid Probes |
2.04.10 |
Admin Update |
23 |
Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment |
6.01.51 |
Minor Update |
24 |
Interventions for Progressive Scoliosis |
2.01.83 |
Admin Update |
25 |
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders |
5.01.16 |
Archived |
26 |
Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes |
7.03.12 |
Minor Update |
27 |
Knee Braces (Custom) |
BSC1.05 |
Admin Update |
28 |
Magnetic Resonance Imaging for Detection and Diagnosis of Breast Cancer |
6.01.29 |
Minor Update |
29 |
Magnetic Resonance Imaging-Targeted Biopsy of the Prostate |
7.01.152 |
Archived |
30 |
Measurement of Serum Antibodies to Selected Biologic Agents |
2.04.84 |
Admin Update |
31 |
Multitarget Polymerase Chain Reaction Testing for Diagnosis of Bacterial Vaginosis |
2.04.127 |
Admin Update |
32 |
Myocardial Sympathetic Innervation Imaging in Individuals With Heart Failure |
6.01.56 |
Minor Update |
33 |
Oncology: Algorithmic Testing |
BSC_CON_2.05 |
Admin Update |
34 |
Oncology: Cancer Screening |
BSC_CON_2.09 |
Admin Update |
35 |
Oncology: Molecular Analysis Of Solid Tumors And Hematologic Malignancies |
BSC_CON_2.04 |
Admin Update |
36 |
Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions |
1.01.15 |
Admin Update |
37 |
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence |
1.01.17 |
Admin Update |
38 |
Percutaneous and Subcutaneous Tibial Nerve Stimulation |
7.01.106 |
Admin Update |
39 |
Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis |
1.01.28 |
Admin Update |
40 |
Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities |
1.03.04 |
Admin Update |
41 |
Radioactive Seed Localization of Nonpalpable Breast Lesions |
6.01.57 |
Minor Update |
42 |
Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors |
7.01.95 |
Minor Update |
43 |
Risk-Reducing Mastectomy |
7.01.09 |
Minor Update |
44 |
Scintimammography and Gamma Imaging of the Breast and Axilla |
6.01.18 |
Minor Update |
45 |
Thermography |
6.01.12 |
Minor Update |
46 |
Virtual Colonoscopy/Computed Tomography Colonography |
6.01.32 |
Minor Update |
47 |
Whole Body Dual X-Ray Absorptiometry to Determine Body Composition |
6.01.40 |
Minor Update |
48 |
Whole Gland Cryoablation of Prostate Cancer |
7.01.79 |
Archived |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective October 1, 2024
|
Policy Title |
Policy# |
Status |
---|---|---|---|
1 |
High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell's Palsy |
2.01.108 |
|
2 |
Allogeneic Pancreas Transplant |
7.03.02 |
Minor Update |
3 |
Biofeedback as a Treatment of Urinary Incontinence in Adults |
2.01.27 |
Minor Update |
4 |
Composite Tissue Allotransplantation of the Hand and Face |
7.03.13 |
Minor Update |
5 |
Endovascular Stent Grafts for Disorders of the Thoracic Aorta |
7.01.86 |
Minor Update |
6 |
Gender Affirmation Surgery |
BSC7.02 |
Admin Update |
7 |
Germline Genetic Testing for Hereditary Diffuse Gastric Cancer (CDH1, CTNNA1) |
2.04.154 |
Archived |
8 |
Heart Transplant |
7.03.09 |
Minor Update |
9 |
Heart/Lung Transplant |
7.03.08 |
Minor Update |
10 |
Hip Arthroplasty for Adults |
BSC7.11 |
Minor Update |
11 |
Isolated Small Bowel Transplant |
7.03.04 |
Minor Update |
12 |
Kidney Transplant |
7.03.01 |
Minor Update |
13 |
Lipid Apheresis |
BSC8.07 |
Archived |
14 |
Liver Transplant and Combined Liver-Kidney Transplant |
7.03.06 |
Minor Update |
15 |
Lung and Lobar Lung Transplant |
7.03.07 |
Minor Update |
16 |
Magnetic Resonance Imaging-Targeted Biopsy of the Prostate |
7.01.152 |
Minor Update |
17 |
Magnetoencephalography/Magnetic Source Imaging |
BSC6.05 |
Minor Update |
18 |
Navigated Transcranial Magnetic Stimulation |
2.01.90 |
Archived |
19 |
Neurofeedback |
2.01.28 |
Archived |
20 |
Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions |
1.01.15 |
Minor Update |
21 |
Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome |
4.01.18 |
Minor Update |
22 |
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence |
1.01.17 |
Minor Update |
23 |
Percutaneous and Subcutaneous Tibial Nerve Stimulation |
7.01.106 |
Minor Update |
24 |
Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel Syndrome |
2.01.106 |
Minor Update |
25 |
Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux |
7.01.102 |
Minor Update |
26 |
Prostatic Urethral Lift |
7.01.151 |
Minor Update |
27 |
Radiation Oncology |
BSC8.06 |
Admin Update |
28 |
Reconstructive Breast Surgery/Management of Breast Implants |
7.01.22 |
Admin Update |
29 |
Reproductive Techniques |
4.02.04 |
Minor Update |
30 |
Retinal Prosthesis |
9.03.15 |
Archived |
31 |
Serologic Genetic and Molecular Screening for Colorectal Cancer |
2.04.150 |
Archived |
32 |
Small Bowel/Liver and Multivisceral Transplant |
7.03.05 |
Minor Update |
33 |
Stereotactic Radiosurgery and Stereotactic Body Radiotherapy |
6.01.10 |
Admin Update |
34 |
Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation |
7.01.172 |
Minor Update |
35 |
Total Artificial Hearts and Implantable Ventricular Assist Devices |
7.03.11 |
Minor Update |
36 |
Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis |
2.02.16 |
Archived |
37 |
Uterus Transplantation for Absolute Uterine Factor Infertility |
4.02.06 |
Minor Update |
38 |
Whole Gland Cryoablation of Prostate Cancer |
7.01.79 |
Minor Update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective August 1, 2024
|
Policy Title |
Policy# |
Status |
---|---|---|---|
1 |
Reconstructive Breast Surgery/Management of Breast Implants |
7.01.22 |
Major Update |
2 |
Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders |
2.01.61 |
New |
3 |
Actigraphy |
2.01.73 |
Minor Update |
4 |
Autonomic Nervous System Testing |
2.01.96 |
Minor Update |
5 |
Bronchial Thermoplasty |
7.01.127 |
Minor Update |
6 |
Bronchial Valves |
7.01.128 |
Minor Update |
7 |
Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting |
2.02.24 |
Minor Update |
8 |
Diagnosis of Obstructive Sleep Apnea Syndrome |
2.01.18 |
Minor Update |
9 |
Electromagnetic Navigational Bronchoscopy |
7.01.122 |
Minor Update |
10 |
Electromyography and Nerve Conduction Studies |
2.01.95 |
Minor Update |
11 |
External Insulin Infusion Pump |
BSC1.03 |
Minor Update |
12 |
Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions |
2.01.40 |
Minor Update |
13 |
Gender Affirmation Surgery |
BSC7.02 |
Admin Update |
14 |
Genetic Testing for Alpha Thalassemia |
2.04.104 |
Archived |
15 |
Home Cardiorespiratory Monitoring |
1.01.06 |
Minor Update |
16 |
Hyperbaric Oxygen Therapy |
2.01.04 |
Minor Update |
17 |
Identification of Microorganisms Using Nucleic Acid Probes |
2.04.10 |
Minor Update |
18 |
Interferential Current Stimulation |
1.01.24 |
Minor Update |
19 |
Low-Level Laser Therapy |
2.01.56 |
Minor Update |
20 |
Lung Volume Reduction Surgery for Severe Emphysema |
7.01.71 |
Minor Update |
21 |
Medical Management of Obstructive Sleep Apnea Syndrome |
8.01.67 |
Minor Update |
22 |
Minimally Invasive Ablation Procedures for Morton and Other Peripheral Neuromas |
7.01.147 |
Minor Update |
23 |
Multicancer Early Detection Testing |
2.04.158 |
Minor Update |
24 |
Navigated Transcranial Magnetic Stimulation |
2.01.90 |
Minor Update |
25 |
Neurofeedback |
2.01.28 |
Minor Update |
26 |
Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain |
2.01.35 |
Minor Update |
27 |
Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy |
7.01.29 |
Minor Update |
28 |
Polysomnography for Non-Respiratory Sleep Disorders |
2.01.99 |
Minor Update |
29 |
Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia |
2.02.18 |
Archived |
30 |
Proteogenomic Testing for Patients With Cancer |
2.04.140 |
Minor Update |
31 |
Quantitative Sensory Testing |
2.01.39 |
Minor Update |
32 |
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases |
2.04.123 |
Minor Update |
33 |
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome |
7.01.101 |
Minor Update |
34 |
Transcatheter Pulmonary Valve Implantation |
7.01.131 |
Minor Update |
35 |
Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy |
2.01.49 |
Minor Update |
36 |
Treatment of Hyperhidrosis |
8.01.19 |
Minor Update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective July 1, 2024
|
Policy Title – July 1, 2024 |
Policy# |
Status |
---|---|---|---|
1 |
Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay |
BSC_CON_2.13 |
New |
2 |
Cervical Spine Surgery |
BSC_NIA_CG_307 |
Major Update |
3 |
Epidural Spine Injections |
BSC_NIA_CG_300 |
Major Update |
4 |
Gender Affirmation Surgery |
BSC7.02 |
Major Update |
5 |
Genetic Testing: Exome and Genome Sequencing For The Diagnosis Of Genetic Disorders |
BSC_CON_2.02 |
Major Update |
6 |
Genetic Testing: Immune, Autoimmune, And Rheumatoid Disorders |
BSC_CON_2.21 |
Major Update |
7 |
Genetic Testing: Kidney Disorders |
BSC_CON_2.22 |
Major Update |
8 |
Genetic Testing: Lung Disorders |
BSC_CON_2.23 |
Major Update |
9 |
Genetic Testing: Pharmacogenetics |
BSC_CON_2.12 |
Major Update |
10 |
Implantable Cardioverter Defibrillators |
7.01.44 |
Major Update |
11 |
Lumbar Spine Surgery |
BSC_NIA_CG_304 |
Major Update |
12 |
Oncology: Algorithmic (Genetic Expression) Testing |
BSC_CON_2.05 |
Major Update |
13 |
Oncology: Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy) |
BSC_CON_2.10 |
Major Update |
14 |
Oncology: Cytogenetic Testing |
BSC_CON_2.11 |
Major Update |
15 |
Oncology: Molecular Analysis Of Solid Tumors And Hematologic Malignancies |
BSC_CON_2.04 |
Major Update |
16 |
Paravertebral Facet Joint Injections or Blocks |
BSC_NIA_CG_301 |
Major Update |
17 |
Sacroiliac Joint Injections |
BSC_NIA_CG_305 |
Major Update |
18 |
Wearable Cardioverter Defibrillators |
2.02.15 |
Major Update |
19 |
Allograft Injection for Degenerative Disc Disease |
7.01.166 |
Minor Update |
20 |
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry |
2.02.08 |
Minor Update |
21 |
Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions |
7.01.78 |
Minor Update |
22 |
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions |
7.01.48 |
Minor Update |
23 |
Baroreflex Stimulation Devices |
8.01.57 |
Minor Update |
24 |
Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure |
2.02.10 |
Minor Update |
25 |
Closure Devices for Patent Foramen Ovale and Atrial Septal Defects |
2.02.09 |
Minor Update |
26 |
Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy |
9.03.05 |
Archived |
27 |
Digital Health Technologies: Therapeutic Applications |
3.03.02 |
Minor Update |
28 |
Electrical Bone Growth Stimulation of the Appendicular Skeleton |
7.01.07 |
Minor Update |
29 |
Endovascular Stent Grafts for Abdominal Aortic Aneurysms |
7.01.67 |
Minor Update |
30 |
Endovascular Therapies for Extracranial Vertebral Artery Disease |
7.01.148 |
Minor Update |
31 |
Enhanced External Counterpulsation |
2.02.06 |
Minor Update |
32 |
Extracorporeal Membrane Oxygenation for Adult Conditions |
8.01.60 |
Minor Update |
33 |
Extracranial Carotid Artery Stenting |
7.01.68 |
Minor Update |
34 |
Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer |
2.04.61 |
Archived |
35 |
Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies |
2.04.59 |
Archived |
36 |
Germline and Somatic Biomarker Testing for Targeted Treatment and Immunotherapy in Ovarian Cancer (BRCA1, BRCA2, Homologous Recombination Deficiency, Tumor Mutational Burden, Microsatellite Instability/Mismatch Repair) |
2.04.156 |
Archived |
37 |
Germline and Somatic Biomarker Testing for Targeted Treatment and Immunotherapy in Prostate Cancer (BRCA1/2, Homologous Recombination Repair Gene Alterations, Microsatellite Instability/Mismatch Repair, Tumor Mutational Burden) |
2.04.155 |
Archived |
38 |
Immediate and Delayed Lymphatic Reconstruction Surgery |
BSC7.18 |
Minor Update |
39 |
Inhaled Nitric Oxide |
8.01.37 |
Minor Update |
40 |
Interventions for Progressive Scoliosis |
2.01.83 |
Minor Update |
41 |
Intradialytic Parenteral Nutrition |
8.01.44 |
Minor Update |
42 |
Intraoperative Neurophysiologic Monitoring |
7.01.58 |
Minor Update |
43 |
Leadless Cardiac Pacemakers |
2.02.32 |
Minor Update |
44 |
Lower Limb Prostheses |
BSC1.01 |
Minor Update |
45 |
Myocardial Strain Imaging |
2.02.31 |
Minor Update |
46 |
Neuropsychological Testing |
BSC2.06 |
Minor Update |
47 |
Orthoptic Training for the Treatment of Vision or Learning Disabilities |
9.03.03 |
Archived |
48 |
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation |
2.02.26 |
Minor Update |
49 |
Phrenic Nerve Stimulation for Central Sleep Apnea |
2.02.33 |
Minor Update |
50 |
Power Wheelchairs and Power Operated Vehicles for Permanent Use |
BSC1.02 |
Minor Update |
51 |
Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia |
2.02.18 |
Minor Update |
52 |
Speech Therapy |
BSC8.02 |
Minor Update |
53 |
Thoracic Spine Surgery |
BSC_NIA_CG_308 |
Minor Update |
54 |
Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis |
2.02.16 |
Minor Update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective June 1, 2024
|
Policy Title – June 1, 2024 |
Policy# |
Status |
---|---|---|---|
1 |
Minimally invasive approaches to vertebral fractures and osteolytic lesions of the spine |
6.01.25 |
Major update |
2 |
Genetic testing: Epilepsy, neurodegenerative, and neuromuscular disorders |
BSC_CON_2.14 |
New |
3 |
Behavioral health treatment for autism spectrum disorders |
BSC3.01 |
Minor update |
4 |
Bone morphogenetic protein |
7.01.100 |
Minor update |
5 |
Catheter ablation for cardiac arrhythmias |
BSC2.12 |
Minor update |
6 |
Deep brain stimulation |
7.01.63 |
Minor update |
7 |
Diabetes prevention program |
BSC2.11 |
Minor update |
8 |
Dry needling of trigger points for myofascial pain |
2.01.100 |
Minor update |
9 |
Electrical stimulation of the spine as an adjunct to spinal fusion procedures |
7.01.85 |
Minor update |
10 |
Endovascular procedures for intracranial arterial disease (atherosclerosis and aneurysms) |
2.01.54 |
Minor update |
11 |
Facet arthroplasty |
7.01.120 |
Minor update |
12 |
Genetic testing for Alzheimer's disease |
2.04.13 |
Archived |
13 |
Genetic testing for Duchenne and Becker muscular dystrophy |
2.04.86 |
Archived |
14 |
Genetic testing for Limb-Girdle muscular dystrophies |
2.04.132 |
Archived |
15 |
Genetic testing for Rett syndrome |
2.04.81 |
Archived |
16 |
Genetic testing of CADASIL syndrome |
2.04.75 |
Archived |
17 |
Hip resurfacing |
7.01.80 |
Minor update |
18 |
Image-guided minimally invasive decompression for spinal stenosis |
7.01.126 |
Minor update |
19 |
Intensity-modulated radiotherapy of the prostate |
8.01.47 |
Minor update |
20 |
Lipid apheresis |
BSC8.07 |
Minor update |
21 |
Manipulation under anesthesia |
8.01.40 |
Minor update |
22 |
Meniscal allografts and other meniscal implants |
7.01.15 |
Minor update |
23 |
Nerve graft with radical prostatectomy |
7.01.81 |
Minor update |
24 |
Occipital nerve stimulation |
7.01.125 |
Minor update |
25 |
Orthopedic applications of platelet-rich plasma |
2.01.98 |
Minor update |
26 |
Percutaneous balloon kyphoplasty, radiofrequency kyphoplasty, and mechanical vertebral augmentation |
6.01.38 |
Archived |
27 |
Peripheral subcutaneous field stimulation |
7.01.139 |
Minor update |
28 |
Physical therapy |
BSC8.03 |
Minor update |
29 |
Power morcellation for the treatment of uterine fibroids |
BSC7.06 |
Minor update |
30 |
Reconstructive Ssrvices |
BSC7.08 |
Minor update |
31 |
Responsive neurostimulation for the treatment of refractory focal epilepsy |
7.01.143 |
Minor update |
32 |
Sacral nerve neuromodulation/stimulation |
7.01.69 |
Minor update |
33 |
Spinal cord and dorsal root ganglion stimulation |
7.01.25 |
Minor update |
34 |
Subtalar arthroereisis |
7.01.104 |
Minor update |
35 |
Surgical treatment of femoroacetabular impingement |
7.01.118 |
Minor update |
36 |
Trigger point and tender point injections |
2.01.103 |
Minor update |
37 |
Vertebral axial decompression |
8.03.09 |
Minor update |
38 |
Vertical expandable prosthetic titanium rib |
7.01.110 |
Minor update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective May 1, 2024
|
Policy Title – May 1, 2024 |
Policy# |
Status |
---|---|---|---|
1 |
Cardiac rehabilitation in the outpatient setting |
8.03.08 |
Major update |
2 |
Myoelectric prosthetic and orthotic components for the upper limb |
1.04.04 |
Major Update |
3 |
Functional endoscopic sinus surgery for chronic rhinosinusitis |
7.01.155 |
New |
4 |
Genetic testing: Gastroenterologic disorders (non-cancerous) |
BSC_CON_2.17 |
New |
5 |
Genetic testing: Hereditary cancer susceptibility |
BSC_CON_2.01 |
New |
6 |
Transmyocardial revascularization |
7.01.54 |
New |
7 |
Vestibular function testing |
2.01.104 |
New |
8 |
Adjustable cranial orthoses for positional plagiocephaly and craniosynostoses |
1.01.11 |
Minor update |
9 |
Amniotic membrane and amniotic fluid |
7.01.149 |
Minor update |
10 |
Bioengineered skin and soft tissue substitutes |
7.01.113 |
Minor update |
11 |
Cognitive rehabilitation |
8.03.10 |
Minor update |
12 |
Continuous passive motion in the home setting |
1.01.10 |
Minor update |
13 |
Cooling devices used in the outpatient setting |
1.01.26 |
Minor update |
14 |
Corneal collagen cross-linking |
9.03.28 |
Minor update |
15 |
Corneal topography/computer-assisted corneal topography/photokeratoscopy |
9.03.05 |
Minor update |
16 |
Cryoablation, radiofrequency ablation, and laser ablation for treatment of chronic rhinitis |
7.01.168 |
Minor update |
17 |
Electrical and electromagnetic stimulation for the treatment of arthritis |
1.01.27 |
Minor update |
18 |
Endothelial keratoplasty |
9.03.22 |
Minor update |
19 |
Evaluation of biomarkers for Alzheimer disease |
2.04.14 |
Admin coding update |
20 |
Eyelid thermal pulsation for the treatment of dry eye syndrome |
9.03.29 |
Minor update |
21 |
Functional neuromuscular electrical stimulation |
8.03.01 |
Minor update |
22 |
Genetic cancer susceptibility panels using next-generation sequencing |
2.04.93 |
Archived |
23 |
Genetic testing for Duchenne and Becker muscular dystrophy |
2.04.86 |
Minor update |
24 |
Genetic testing for hereditary hemochromatosis |
2.04.80 |
Archived |
25 |
Genetic testing for lactase insufficiency |
2.04.94 |
Archived |
26 |
Genetic testing for Lynch syndrome and other inherited colon cancer syndromes |
2.04.08 |
Archived |
27 |
Genetic testing: Prenatal and preconception carrier screening |
BSC_CON_2.07 |
Admin coding update |
28 |
Germline genetic testing for familial cutaneous malignant melanoma (CDKN2A, CDK4) |
2.04.44 |
Archived |
29 |
Germline genetic testing for gene variants associated with breast cancer in individuals at high breast cancer risk (CHEK2, ATM, and BARD1) | 2.04.126 |
Archived |
30 |
Germline genetic testing for hereditary breast/ovarian cancer syndrome and other high-risk cancers (BRCA1, BRCA2, PALB2) | 2.04.02 |
Archived |
31 |
Germline genetic testing for ovarian cancer risk (BRIP1, RAD51C, RAD51D, NBN) |
2.04.149 |
Archived |
32 |
Germline genetic testing for pancreatic cancer susceptibility genes (ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, and TP53) | 2.04.148 |
Archived |
33 |
Hippotherapy |
8.03.12 |
Minor update |
34 |
Home non-invasive positive airway pressure devices for the treatment of respiratory insufficiency and failure |
8.01.64 |
Minor update |
35 |
Human leukocyte antigen testing for celiac disease |
2.04.95 |
Archived |
36 |
Identification of microorganisms using nucleic acid probes |
2.04.10 |
Admin coding update |
37 |
Intraocular radiotherapy for age-related macular degeneration |
9.03.20 |
Minor update |
38 |
Keratoprosthesis |
9.03.01 |
Minor update |
39 |
Knee braces (custom) |
BSC1.05 |
Minor update |
40 |
Lifestyle modification program for reversing heart disease |
BSC8.01 |
Minor update |
41 |
Low intensity pulsed ultrasound fracture healing device |
1.01.05 |
Minor update |
42 |
Microprocessor-controlled prostheses for the lower limb |
1.04.05 |
Minor update |
43 |
Noninvasive techniques for the evaluation and monitoring of patients with chronic liver disease |
2.04.41 |
Archived |
44 |
Oncology: Molecular analysis of solid tumors and hematologic malignancies |
BSC_CON_2.04 |
Admin coding update |
45 |
Ophthalmologic techniques that evaluate the posterior segment for glaucoma |
9.03.06 |
Minor update |
46 |
Optical coherence tomography of the anterior eye segment |
9.03.18 |
Minor update |
47 |
Orthognathic surgery |
BSC7.03 |
Minor update |
48 |
Orthoptic training for the treatment of vision or learning disabilities |
9.03.03 |
Minor update |
49 |
Outpatient pulmonary rehabilitation |
8.03.05 |
Minor update |
50 |
Panniculectomy, abdominoplasty, and surgical management of diastasis recti |
BSC7.04 |
Minor update |
51 |
Partial thickness rotator cuff tears and acromioplasty/subacromial decompression |
BSC7.14 |
Minor update |
52 |
Patient-controlled end range of motion stretching devices |
1.03.05 |
Minor update |
53 |
Personalized breast cancer screening clinical trial |
BSC2.08 |
Minor update |
54 |
Photodynamic therapy for choroidal neovascularization |
9.03.08 |
Minor update |
55 |
Pneumatic compression pumps for treatment of lymphedema and venous ulcers |
1.01.18 |
Minor update |
56 |
Postsurgical home use of limb compression devices for venous thromboembolism prophylaxis |
1.01.28 |
Minor update |
57 |
Power wheelchairs and power operated vehicles for permanent use |
BSC1.02 |
Admin coding update |
58 |
Powered exoskeleton for ambulation in patients with lower-limb disabilities |
1.03.04 |
Minor update |
59 |
Retinal prosthesis |
9.03.15 |
Minor update |
60 |
Retinal telescreening for diabetic retinopathy |
9.03.13 |
Minor update |
61 |
Sacral nerve neuromodulation/stimulation |
7.01.69 |
Admin coding update |
62 |
Sensory integration therapy and auditory integration therapy |
8.03.13 |
Minor update |
63 |
Serum biomarker panel testing for systemic lupus erythematosus and other connective tissue diseases | 2.04.123 |
Admin coding update |
64 |
Treatment of varicose veins/venous insufficiency |
7.01.124 |
Admin coding update |
65 |
Vagus nerve stimulation |
7.01.20 |
Admin coding update |
66 |
Viscocanalostomy and canaloplasty |
9.03.26 |
Minor update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective April 1, 2024
|
Policy Title – April 1, 2024 |
Policy# |
Status |
---|---|---|---|
1 |
Auditory brainstem implant |
7.01.83 |
|
2 |
Biomarker testing in risk assessment and management of cardiovascular disease |
2.04.65 |
|
3 |
Transcatheter aortic-valve implantation for aortic stenosis |
7.01.132 |
|
4 |
Cochlear implant |
7.01.05 |
|
5 |
Fractional carbon dioxide (CO2) laser ablation treatment of hypertrophic scars or keloids for functional improvement |
2.01.107 |
|
6 |
Genetic testing: Hematologic conditions (non-cancerous) |
BSC_CON_2.15 |
|
7 |
Genetic testing: Kidney disorders |
BSC_CON_2.22 |
|
8 |
Genetic testing: Metabolic, endocrine, and mitochondrial disorders |
BSC_CON_2.24 |
|
9 |
Hematopoietic cell transplantation for epithelial ovarian cancer |
8.01.23 |
|
10 |
Hematopoietic cell transplantation for miscellaneous solid tumors in adults |
8.01.24 |
|
11 |
Surgery for groin pain in athletes |
7.01.142 |
|
12 |
Treatment of tinnitus |
8.01.39 |
|
13 |
Vagus nerve stimulation |
7.01.20 |
|
14 |
Allogeneic hematopoietic cell transplantation for myelodysplastic syndromes and myeloproliferative neoplasms |
8.01.21 |
Minor update |
15 |
Ambulatory surgery center |
BSC10.01 |
Minor update |
16 |
Balloon ostial dilation for treatment of chronic and recurrent acute rhinosinusitis |
7.01.105 |
Minor update |
17 |
Cardiovascular risk panels |
2.04.100 |
Archived |
18 |
Chelation therapy for off-label uses |
8.01.02 |
Minor update |
19 |
Chronic intermittent intravenous insulin therapy |
2.01.43 |
Minor update |
20 |
Cleft palate – Dental related services |
BSC2.01 |
Minor update |
21 |
Continuous glucose monitoring |
1.01.20 |
Minor update |
22 |
Cranial electrotherapy stimulation and auricular electrostimulation |
8.01.58 |
Minor update |
23 |
Dental anesthesia |
BSC2.02 |
Minor update |
24 |
Dynamic posturography |
2.01.02 |
Minor update |
25 |
Gastric electrical stimulation |
7.01.73 |
Minor update |
26 |
Gender affirmation surgery |
BSC7.02 |
Minor update |
27 |
Genetic testing for inherited thrombophilia |
2.04.82 |
Archived |
28 |
Genetic testing for mitochondrial disorders |
2.04.117 |
Archived |
29 |
Handheld radiofrequency spectroscopy for intraoperative assessment of surgical margins during breast-conserving surgery |
7.01.140 |
Minor update |
30 |
Hematopoietic cell transplantation for acute lymphoblastic leukemia |
8.01.32 |
Minor update |
31 |
Hematopoietic cell transplantation for acute myeloid leukemia |
8.01.26 |
Minor update |
32 |
Hematopoietic cell transplantation for autoimmune diseases |
8.01.25 |
Minor update |
33 |
Hematopoietic cell transplantation for central nervous system embryonal tumors and ependymoma |
8.01.28 |
Minor update |
34 |
Hematopoietic cell transplantation for chronic lymphocytic leukemia/small lymphocytic lymphoma |
8.01.15 |
Minor update |
35 |
Hematopoietic cell transplantation for chronic myeloid leukemia |
8.01.30 |
Minor update |
36 |
Hematopoietic cell transplantation for Hodgkin lymphoma |
8.01.29 |
Minor update |
37 |
Hematopoietic cell transplantation for non-Hodgkin lymphomas |
8.01.20 |
Minor update |
38 |
Hematopoietic cell transplantation for plasma cell dyscrasias, including multiple myeloma and POEMS syndrome |
8.01.17 |
Minor update |
39 |
Hematopoietic cell transplantation for primary amyloidosis |
8.01.42 |
Minor update |
40 |
Hematopoietic cell transplantation for solid tumors of childhood |
8.01.34 |
Minor update |
41 |
Hematopoietic cell transplantation in the treatment of germ cell tumors |
8.01.35 |
Minor update |
42 |
Hysterectomy surgery for benign conditions |
BSC7.09 |
Minor update |
43 |
Implantable bone-conduction and bone-anchored hearing aids |
7.01.03 |
Minor update |
44 |
Laboratory tests post transplant and for heart failure |
2.01.68 |
Archived |
45 |
Laparoscopic, percutaneous, and transcervical techniques for uterine fibroid myolysis |
4.01.19 |
Minor update |
46 |
Maternal serum biomarkers for prediction of adverse obstetric outcomes |
2.04.152 |
Minor update |
47 |
Measurement of lipoprotein-sssociated phospholipase A2 in the assessment of cardiovascular risk |
2.04.32 |
Archived |
48 |
Radiation oncology |
BSC8.06 |
Admin update |
49 |
Reduction mammaplasty for breast-related symptoms |
7.01.21 |
Minor update |
50 |
Semi-implantable and fully implantable middle ear hearing aids |
7.01.84 |
Minor update |
51 |
Steroid-eluting sinus stents and implants |
7.01.134 |
Minor update |
52 |
Surgical deactivation of headache trigger sites |
7.01.135 |
Minor update |
53 |
Surgical ventricular restoration | 7.01.103 |
Minor update |
54 |
Temporomandibular joint disorder |
2.01.21 |
Minor update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for Biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective March 1, 2024
|
Policy Title – March 1, 2024 |
Policy# |
Status |
---|---|---|---|
1 |
Treatment of varicose veins/venous insufficiency |
7.01.124 |
|
2 |
Chemical peels |
8.01.16 |
|
3 |
Fecal calprotectin testing |
2.04.69 |
|
4 |
Homocysteine testing in the screening, diagnosis, and management of cardiovascular disease and venous thromboembolic disorders |
2.04.23 |
|
5 |
Intracellular micronutrient analysis |
2.04.73 |
|
6 |
Radiofrequency coblation tenotomy for musculoskeletal conditions |
7.01.165 |
|
7 |
Targeted phototherapy and psoralen with ultraviolet A for vitiligo |
2.01.86 |
|
8 |
Adipose-derived stem cells in autologous fat grafting to the breast |
7.01.153 |
Minor update |
9 |
Amniotic membrane and amniotic fluid |
7.01.149 |
Admin coding update |
10 |
Autologous platelet-derived growth factors for wound healing and other non-orthopedic conditions |
2.01.16 |
Minor update |
11 |
Bioimpedance devices for detection and management of lymphedema |
2.01.82 |
Minor update |
12 |
Biventricular pacemakers (cardiac resynchronization therapy) for the treatment of heart failure |
2.02.10 |
Admin coding update |
13 |
Blepharoplasty, blepharoptosis repair (levator resection) and brow lift (repair of brow ptosis) |
BSC7.01 |
Minor update |
14 |
Bone turnover markers for the diagnosis and management of osteoporosis and diseases associated with high bone turnover |
2.04.15 |
Minor update |
15 |
Charged-particle (proton or helium ion) radiotherapy for neoplastic conditions |
BSC8.04 |
Minor update |
16 |
Cranial electrotherapy stimulation and auricular electrostimulation |
8.01.58 |
Admin coding update |
17 |
Cryoablation, radiofrequency ablation, and laser ablation for treatment of chronic rhinitis |
7.01.168 |
Admin coding update |
18 |
Electrostimulation and electromagnetic therapy for treating wounds |
2.01.57 |
Minor update |
19 |
Gastric electrical stimulation |
7.01.73 |
Admin coding update |
20 |
Genetic testing: Exome and genome sequencing for the diagnosis of genetic disorders |
BSC_CON_2.02 |
Admin coding update |
21 |
Genetic testing: Pharmacogenetics |
BSC_CON_2.12 |
Admin coding update |
22 |
Germline genetic testing for pancreatic cancer susceptibility genes (ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, and TP53) |
2.04.148 |
Admin coding update |
23 |
Hyperthermic intraperitoneal chemotherapy for select intra-abdominal and pelvic malignancies |
2.03.07 |
Admin coding update |
24 |
Ingestible pH and pressure capsule |
BSC2.17 |
Minor update |
25 |
Intensity-modulated radiotherapy of the breast and lung |
8.01.46 |
Minor update |
26 |
Intensity-modulated radiotherapy: Abdomen, pelvis and chest |
8.01.49 |
Minor update |
27 |
Intensity-modulated radiotherapy: Cancer of the head and neck or thyroid |
8.01.48 |
Minor update |
28 |
Intensity-modulated radiotherapy: Central nervous system tumors |
8.01.59 |
Minor update |
29 |
Interventions for progressive scoliosis |
2.01.83 |
Admin coding update |
30 |
Laparoscopic, percutaneous, and transcervical techniques for uterine fibroid myolysis |
4.01.19 |
Admin coding update |
31 |
Lower limb prostheses |
BSC1.01 |
Admin coding update |
32 |
Low-level laser therapy |
2.01.56 |
Admin coding update |
33 |
Lysis of epidural adhesions |
BSC8.05 |
Minor update |
34 |
Medical management of obstructive sleep apnea syndrome |
8.01.67 |
Admin coding update |
35 |
Microprocessor-controlled prostheses for the lower limb |
1.04.05 |
Admin coding update |
36 |
Negative pressure wound therapy in the outpatient setting |
1.01.16 |
Minor update |
37 |
Noncontact ultrasound treatment for wounds |
2.01.79 |
Minor update |
38 |
Noninvasive techniques for the evaluation and monitoring of patients with chronic liver disease |
2.04.41 |
Admin coding update |
39 |
Oncology: Algorithmic (genetic expression) testing |
BSC_CON_2.05 |
Admin coding update |
40 |
Oncology: Circulating tumor DNA and circulating tumor cells (liquid biopsy) |
BSC_CON_2.10 |
Admin coding update |
41 |
Oncology: Molecular analysis of solid tumors and hematologic malignancies |
BSC_CON_2.04 |
Admin coding update |
42 |
Orthopedic applications of stem cell therapy (Including allografts and bone substitutes used with autologous bone marrow) |
8.01.52 |
Minor update |
43 |
Percutaneous and subcutaneous tibial nerve stimulation |
7.01.106 |
Admin coding update |
44 |
Phrenic nerve stimulation for central sleep apnea |
2.02.33 |
Admin coding update |
45 |
Pneumatic compression pumps for treatment of lymphedema and venous ulcers |
1.01.18 |
Admin coding update |
46 |
Radiation oncology |
BSC8.06 |
Minor update |
47 |
Remote electrical neuromodulation for migraines |
7.01.171 |
Admin coding update |
48 |
Responsive neurostimulation for the treatment of refractory focal epilepsy |
7.01.143 |
Admin coding update |
49 |
Sacral nerve neuromodulation/stimulation |
7.01.69 |
Admin coding update |
50 |
Spinal cord and dorsal root ganglion stimulation |
7.01.25 |
Admin coding update |
51 |
Stem cell therapy for peripheral arterial disease |
8.01.55 |
Minor update |
52 |
Stereotactic radiosurgery and stereotactic body radiotherapy |
6.01.10 |
Minor update |
53 |
Surgical treatment of gynecomastia |
BSC7.13 |
Minor update |
54 |
Surgical treatment of snoring and obstructive sleep apnea syndrome |
7.01.101 |
Admin coding update |
55 |
Temporarily implanted nitinol device (iTind) for benign prostatic hyperplasia |
7.01.175 |
Minor update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective February 1, 2024
|
Policy Title – February 1, 2024 |
Policy# |
Status |
---|---|---|---|
1 |
Genetic testing: General approach to genetic and molecular testing |
BSC_CON_2.27 |
|
2 |
Genetic testing: Prenatal and preconception carrier screening |
BSC_CON_2.07 |
|
3 |
Genetic Testing: Prenatal diagnosis (via amniocentesis, CVS, or PUBS) and pregnancy loss |
BSC_CON_2.06 |
|
4 |
Testing serum vitamin D levels |
2.04.135 |
|
5 |
Biofeedback as a treatment of chronic pain |
2.01.30 |
|
6 |
Biofeedback as a treatment of fecal incontinence or constipation |
2.01.64 |
|
7 |
Biofeedback as a treatment of headache |
2.01.29 |
|
8 |
Biofeedback for miscellaneous indications |
2.01.53 |
|
9 |
Chromoendoscopy as an adjunct to colonoscopy |
2.01.84 |
|
10 |
Fecal microbiota transplantation |
2.01.92 |
|
11 |
Genetic Testing: Dermatologic conditions |
BSC_CON_2.25 |
|
12 |
Genetic testing: Hearing loss |
BSC_CON_2.16 |
|
13 |
Genetic testing: Pharmacogenetics |
BSC_CON_2.12 |
|
14 |
Human leukocyte antigen testing for celiac disease |
2.04.95 |
|
15 |
Intravenous anesthetics for the treatment of chronic pain and psychiatric disorders |
5.01.16 |
|
16 |
Laser treatment of onychomycosis |
2.01.89 |
|
17 |
Nerve fiber density measurement |
2.04.58 |
|
18 |
Neural therapy |
2.01.85 |
|
19 |
Nutrient/nutritional panel testing |
2.04.136 |
|
20 |
Peroral endoscopic myotomy for treatment of esophageal achalasia and gastroparesis |
2.01.91 |
|
21 |
Sphenopalatine ganglion block for headache |
7.01.159 |
|
22 |
Transanal endoscopic microsurgery |
7.01.112 |
|
23 |
Transcutaneous electrical nerve stimulation |
1.01.09 |
|
24 |
Biomarker testing in risk assessment and management of cardiovascular disease |
2.04.65 |
Minor update |
25 |
Cardiovascular risk panels |
2.04.100 |
Minor update |
26 |
Cytochrome P450 genotype-guided treatment strategy |
2.04.38 |
Archived |
27 |
Dermatologic applications of photodynamic therapy |
2.01.44 |
Minor update |
28 |
Fecal analysis in the diagnosis of intestinal dysbiosis |
2.04.26 |
Minor update |
29 |
Genetic testing for diagnosis and management of mental health conditions |
2.04.110 |
Archived |
30 |
Genetic testing for hereditary hearing loss |
2.04.87 |
Archived |
31 |
Genotype-guided tamoxifen treatment |
2.04.51 |
Archived |
32 |
Genotype-guided warfarin dosing |
2.04.48 |
Archived |
33 |
Immune cell function assay |
2.04.56 |
Minor update |
34 |
Laboratory and genetic testing for use of 5-fluorouracil in patients with cancer |
2.04.68 |
Archived |
35 |
Laser interstitial thermal therapy for neurological conditions |
7.01.170 |
Minor update |
36 |
Measurement of lipoprotein-associated phospholipase A2 in the assessment of cardiovascular risk |
2.04.32 |
Minor update |
37 |
Multitarget polymerase chain reaction testing for diagnosis of bacterial vaginosis |
2.04.127 |
Minor update |
38 |
Nonpharmacologic treatment of rosacea |
2.01.71 |
Minor update |
39 |
Oncologic applications of positron emission tomography scanning (genitourinary) |
6.01.26 |
Archived |
40 |
Oncology: Cancer screening |
BSC_CON_2.09 |
Minor update |
41 |
Pharmacogenetic testing for pain management |
2.04.131 |
Archived |
42 |
Pharmacogenomic and metabolite markers for patients treated with thiopurines |
2.04.19 |
Archived |
43 |
Positional magnetic resonance imaging |
6.01.48 |
Archived |
44 |
Serum biomarker human epididymis protein 4 |
2.04.66 |
Minor update |
45 |
Transesophageal endoscopic therapies for gastroesophageal reflux disease |
2.01.38 |
Minor update |
46 |
Wireless capsule endoscopy for gastrointestinal (GI) disorders |
6.01.33 |
Minor update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
New and updated policies effective January 1, 2024
|
Policy Title – January 1, 2024 |
Policy# |
Status |
---|---|---|---|
1 |
Genetic testing: Preimplantation genetic testing |
BSC_CON_2.03 |
|
2 |
Dopamine transporter single-photon emission computed tomography |
6.01.54 |
|
3 |
Extracorporeal photopheresis |
8.01.36 |
|
4 |
Genetic testing: Aortopathies and connective tissue disorders |
BSC_CON_2.19 |
|
5 |
Genetic testing: Cardiac disorders |
BSC_CON_2.18 |
|
6 |
Axillary reverse mapping for prevention of breast cancer-related lymphedema |
7.01.173 |
Minor update |
7 |
Cervical spine surgery |
BSC_NIA_CG_307 |
Minor update |
8 |
Computed tomography to detect coronary artery calcification |
6.01.03 |
Archived |
9 |
Confocal laser endomicroscopy |
2.01.87 |
Minor update |
10 |
Contrast-enhanced coronary computed tomography angiography for coronary artery evaluation |
6.01.43 |
Archived |
11 |
Coronary computed tomography angiography with selective noninvasive fractional flow reserve |
6.01.59 |
Archived |
12 |
Drug testing in pain management and substance use disorder treatment |
2.04.98 |
Minor update |
13 |
Dry hydrotherapy for chronic pain conditions |
2.01.105 |
Minor update |
14 |
Endoscopic radiofrequency ablation or cryoablation for Barrett esophagus |
2.01.80 |
Minor update |
15 |
Epidural spine injections |
BSC_NIA_CG_300 |
Minor update |
16 |
Esophageal pH monitoring |
2.01.20 |
Minor update |
17 |
Genetic testing for cardiac ion channelopathies |
2.04.43 |
Archived |
18 |
Genetic testing for predisposition to inherited hypertrophic cardiomyopathy |
2.02.28 |
Archived |
19 |
Genetic testing: Non-invasive prenatal screening (NIPS)/Non-invasive prenatal testing (NIPT) |
BSC_CON_2.08 |
Minor update |
20 |
Lumbar spine surgery |
BSC_NIA_CG_304 |
Minor update |
21 |
Magnetic esophageal sphincter augmentation to treat gastroesophageal reflux disease |
7.01.137 |
Minor update |
22 |
Measurement of serum antibodies to selected biologic agents |
2.04.84 |
Minor update |
23 |
Monitored anesthesia care |
7.02.01 |
Minor update |
24 |
Noninvasive techniques for the evaluation and monitoring of patients with chronic liver disease |
2.04.41 |
Minor update |
25 |
Paravertebral facet joint injections or blocks |
BSC_NIA_CG_301 |
Minor update |
26 |
Pharmacogenetic testing for pain management |
2.04.131 |
Minor update |
27 |
Pharmacogenomic and metabolite markers for patients treated with thiopurines |
2.04.19 |
Minor update |
28 |
Plugs for anal fistula repair |
7.01.123 |
Minor update |
29 |
Prolotherapy |
2.01.26 |
Minor update |
30 |
Proteomic testing for targeted therapy in non-small cell lung cancer |
2.04.125 |
Minor update |
31 |
Sacroiliac joint injections |
BSC_NIA_CG_305 |
Minor update |
32 |
Thoracic spine surgery |
BSC_NIA_CG_308 |
Minor update |
Please Note:
California Senate Bill 535 (“SB 535”) mandates that health plans are not to require prior authorization for either of the following services:
- Biomarker testing for an enrollee or insured with advanced metastatic stage 3 or 4 cancer, or
- Biomarker testing for cancer progression or recurrence in the enrollee or insured with advanced or metastatic stage 3 or 4 cancer.
Blue Shield of California has removed prior authorization for biomarker testing services. Compliance with SB 535 is required for Blue Shield’s delegated provider organizations, in cases where the organization is financially responsible for those services.
For more coverage information, we encourage you to review our applicable medical or medication policies and benefits online at blueshieldca.com/provider.
Medical policy list
Use these alphabetical lists to find Blue Shield medical policies, and review requirements and criteria for new technologies, devices and procedures.
Find medical policy for Blue Shield of California plans
View clinical policies and procedures for Blue Shield of California Promise Health Plan
Find medical benefit drug policy for Medicare and Commercial plans
Technical evaluation and assessment
Find out about our process of evaluating coverage for new technologies and new applications of existing technologies.