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Medical policy updates

Read about latest medical policy changes.

Attention: Due to technical changes affecting the Medical Policy page on this website, please refer to list of the medical policy updates that will be available below, between May 1, 2024 through July 1, 2024. The policies will not be posted on the Medical Policy page until later in July. 

If you need immediate assistance or to obtain a copy of the medical policies/documents originally scheduled for publication between May 1, 2024 and July 1, 2024, please contact our Medical Policy department at MedPolicy@blueshieldca.com.  We apologize for any inconveniences caused by these technical changes in progress.

  • 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 Services

    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.

     

    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

    Major Update

    2

    Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease

    2.04.65

    Major Update

    3

    Transcatheter Aortic-Valve Implantation for Aortic Stenosis

    7.01.132

    Major Update

    4

    Cochlear Implant

    7.01.05

    New

    5

    Fractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement

    2.01.107

    New

    6

    Genetic Testing: Hematologic Conditions (Non-Cancerous)

    BSC_CON_2.15

    New

    7

    Genetic Testing: Kidney Disorders

    BSC_CON_2.22

    New

    8

    Genetic Testing: Metabolic, Endocrine, And Mitochondrial Disorders

    BSC_CON_2.24

    New

    9

    Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer

    8.01.23

    New

    10

    Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults

    8.01.24

    New

    11

    Surgery for Groin Pain in Athletes

    7.01.142

    New

    12

    Treatment of Tinnitus

    8.01.39

    New

    13

    Vagus Nerve Stimulation

    7.01.20

    New

    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-Associated 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.

     

    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

    Major Update

    2

    Chemical Peels

    8.01.16

    New

    3

    Fecal Calprotectin Testing

    2.04.69

    New

    4

    Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease and Venous Thromboembolic Disorders

    2.04.23

    New

    5

    Intracellular Micronutrient Analysis

    2.04.73

    New

    6

    Radiofrequency Coblation Tenotomy for Musculoskeletal Conditions

    7.01.165

    New

    7

    Targeted Phototherapy and Psoralen with Ultraviolet A for Vitiligo

    2.01.86

    New

    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.

     

    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

    Major Update

    2

    Genetic Testing: Prenatal and Preconception Carrier Screening

    BSC_CON_2.07

    Major Update

    3

    Genetic Testing: Prenatal Diagnosis (Via Amniocentesis, CVS, or PUBS) and Pregnancy Loss

    BSC_CON_2.06

    Major Update

    4

    Testing Serum Vitamin D Levels

    2.04.135

    Major Update

    5

    Biofeedback as a Treatment of Chronic Pain

    2.01.30

    New

    6

    Biofeedback as a Treatment of Fecal Incontinence or Constipation

    2.01.64

    New

    7

    Biofeedback as a Treatment of Headache

    2.01.29

    New

    8

    Biofeedback for Miscellaneous Indications

    2.01.53

    New

    9

    Chromoendoscopy as an Adjunct to Colonoscopy

    2.01.84

    New

    10

    Fecal Microbiota Transplantation

    2.01.92

    New

    11

    Genetic Testing: Dermatologic Conditions

    BSC_CON_2.25

    New

    12

    Genetic Testing: Hearing Loss

    BSC_CON_2.16

    New

    13

    Genetic Testing: Pharmacogenetics

    BSC_CON_2.12

    New

    14

    Human Leukocyte Antigen Testing for Celiac Disease

    2.04.95

    New

    15

    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders

    5.01.16

    New

    16

    Laser Treatment of Onychomycosis

    2.01.89

    New

    17

    Nerve Fiber Density Measurement

    2.04.58

    New

    18

    Neural Therapy

    2.01.85

    New

    19

    Nutrient/Nutritional Panel Testing

    2.04.136

    New

    20

    Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia and Gastroparesis

    2.01.91

    New

    21

    Sphenopalatine Ganglion Block for Headache

    7.01.159

    New

    22

    Transanal Endoscopic Microsurgery

    7.01.112

    New

    23

    Transcutaneous Electrical Nerve Stimulation

    1.01.09

    New

    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

    Major Update

    2

    Dopamine Transporter Single-Photon Emission Computed Tomography

    6.01.54

    New

    3

    Extracorporeal Photopheresis

    8.01.36

    New

    4

    Genetic Testing: Aortopathies and Connective Tissue Disorders

    BSC_CON_2.19

    New

    5

    Genetic Testing: Cardiac Disorders

    BSC_CON_2.18

    New

    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

     

  • New and updated policies effective December 1, 2023

     

    Policy Title – December 1, 2023

    Policy#

    Status

    1

    Genetic Testing: Eye Disorders 

    BSC_CON_2.20

    New

    2

    Genetic Testing: General Approach to Genetic and Molecular Testing

    BSC_CON_2.27

    New

    3

    Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders

    BSC_CON_2.21

    New

    4

    Genetic Testing: Lung Disorders

    BSC_CON_2.23

    New

    5

    Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders

    BSC_CON_2.26

    New

    6

    Oncology: Cytogenetic Testing

    BSC_CON_2.11

    New

    7

    Suture Button Suspensionplasty Fixation System for Thumb Carpometacarpal Osteoarthritis

    7.01.176

    New

    8

    Home Non-Invasive Positive Airway Pressure Devices for the Treatment of Respiratory Insufficiency and Failure

    8.01.64

    Major Update

    9

    Microwave Tumor Ablation

    7.01.133

    Major Update

    10

    Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders

    2.01.50

    Major Update

    11

    Treatment of Varicose Veins/Venous Insufficiency

    7.01.124

    Major Update

    12

    Absorbable Nasal Implant for Treatment of Nasal Valve Collapse

    7.01.163

    Minor Update

    13

    Bioengineered Skin and Soft Tissue Substitutes

    7.01.113

    Admin Update

    14

    Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure

    2.02.10

    Admin Update

    15

    Diagnosis of Obstructive Sleep Apnea Syndrome 2.01.18

    2.01.18

    Admin Update

    16

    Digital Health Therapies for Substance Use Disorders

    5.01.35

    Archived

    17

    Endovascular Stent Grafts for Disorders of the Thoracic Aorta

    7.01.86

    Minor Update

    18

    Evaluation of Biomarkers for Alzheimer Disease

    2.04.14

    Minor Update

    19

    General Approach to Evaluating the Utility of Genetic Panels

    2.04.92

    Archived

    20

    General Approach to Genetic Testing

    2.04.91

    Archived

    21

    Genetic Cancer Susceptibility Panels Using Next-Generation Sequencing

    2.04.93

    Minor Update

    22

    Genetic Testing for Alzheimer Disease

    2.04.13

    Minor Update

    23

    Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies

    2.04.59

    Minor Update

    24

    Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes

    2.04.08

    Minor Update

    25

    Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence

    7.01.19

    Minor Update

    26

    Knee Arthroplasty for Adults

    BSC7.10

    Minor Update

    27

    Knee Arthroscopy in Knee Osteoarthritis

    BSC7.16

    Minor Update

    28

    Laboratory Tests Post Transplant and for Heart Failure

    2.01.68

    Minor Update

    29

    Magnetic Resonance Spectroscopy

    6.01.24

    Minor Update

    30

    Medical Management of Obstructive Sleep Apnea Syndrome

    8.01.67  

    Admin Update

    31

    Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography

    6.01.06

    Minor Update

    32

    Multibiomarker Disease Activity Blood Test for Rheumatoid Arthritis

    2.04.119

    Archived

    33

    Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder

    3.01.03

    Minor Update

    34

    Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension

    7.01.136

    Minor Update

    35

    Remote Electrical Neuromodulation for Migraines

    7.01.171

    Minor Update

    36

    Selected Positron Emission Tomography Technologies for Evaluation of Alzheimer Disease

    6.01.55

    Minor Update

    37

    Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome

    7.01.101

    Admin 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 November 1, 2023

     

    Policy Title – November 1, 2023

    Policy#

    Status

    1

    Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer

    6.01.58

    New

    2

    Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome

    4.01.18

    New

    3

    Percutaneous and Subcutaneous Tibial Nerve Stimulation

    7.01.106

    New

    4

    Radioactive Seed Localization of Nonpalpable Breast Lesions

    6.01.57

    New

    5

    Thermography

    6.01.12

    New

    6

    Whole Body Dual X-Ray Absorptiometry to Determine Body Composition

    6.01.40

    New

    7

    Ablation of Peripheral Nerves to Treat Pain

    7.01.154

    Minor Update

    8

    Amniotic Membrane and Amniotic Fluid

    7.01.149

    Admin Coding

    9

    Aqueous Shunts and Stents for Glaucoma

    9.03.21

    Minor Update

    10

    Balloon Dilation of the Eustachian Tube

    7.01.158

    Minor Update

    11

    Bone Mineral Density Studies

    6.01.01

    Minor Update

    12

    Cardiac Applications of Positron Emission Tomography Scanning

    6.01.20

    Minor Update

    13

    Cardiovascular Risk Panels

    2.04.100

    Admin Coding

    14

    Computed Tomography Perfusion Imaging of the Brain

    6.01.49

    Minor Update

    15

    Cryosurgical Ablation of Primary or Metastatic Liver Tumors

    7.01.75

    Minor Update

    16

    Dynamic Spinal Visualization and Vertebral Motion Analysis

    6.01.46

    Minor Update

    17

    Evaluation of Biomarkers for Alzheimer Disease

    2.04.14

    Admin Coding

    18

    Focal Treatments for Prostate Cancer

    8.01.61

    Minor Update

    19

    Functional Magnetic Resonance Imaging of the Brain

    6.01.47

    Minor Update

    20

    Genetic Testing for Diagnosis and Management of Mental Health Conditions

    2.04.110

    Admin Coding

    21

    Genetic Testing for Mitochondrial Disorders

    2.04.117

    Minor Update

    22

    Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Ovarian Cancer (BRCA1, BRCA2, Homologous Recombination Deficiency)

    2.04.156

    Minor Update

    23

    Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2)

    2.04.02

    Minor Update

    24

    Identification of Microorganisms Using Nucleic Acid Probes

    2.04.10

    Admin Coding

    25

    Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment

    6.01.51

    Minor Update

    26

    Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes

    7.03.12

    Minor Update

    27

    Lower Limb Prostheses

    BSC1.01

    Admin Coding

    28

    Magnetic Resonance Imaging for Detection and Diagnosis of Breast Cancer

    6.01.29

    Minor Update

    29

    Myocardial Sympathetic Innervation Imaging in Patients With Heart Failure

    6.01.56

    Minor Update

    30

    Oncologic Applications of Positron Emission Tomography Scanning

    6.01.26

    Minor Update

    31

    Oncology: Algorithmic (Genetic Expression) Testing

    BSC_CON_2.05

    Admin Coding

    32

    Oncology: Circulating Tumor DNA and Circulating Tumor Cells (Liquid Biopsy)

    BSC_CON_2.10

    Admin Coding

    33

    Oncology: Molecular Analysis Of Solid Tumors And Hematologic Malignancies

    BSC_CON_2.04

    Admin Coding

    34

    Positional Magnetic Resonance Imaging

    6.01.48

    Minor Update

    35

    Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors

    7.01.95

    Minor Update

    36

    Scintimammography and Gamma Imaging of the Breast and Axilla

    6.01.18

    Minor Update

    37

    Stationary Ultrasonic Diathermy Devices

    7.01.174

    Admin Coding

    38

    Synthetic Cartilage Implants for Joint Pain

    7.01.160

    Minor Update

    39

    Vertebral Fracture Assessment with Densitometry

    6.01.44

    Minor Update

    40

    Virtual Colonoscopy/Computed Tomography Colonography

    6.01.32

    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 October 1, 2023

     

    Policy Title –October 1, 2023

    Policy#

    Status

    1

    Bariatric Surgery

    7.01.47   

    Major Update

    2

    Composite Tissue Allotransplantation of the Hand and Face

    7.03.13

    New

    3

    Magnetic Resonance Imaging-Targeted Biopsy of the Prostate

    7.01.152

    New

    4

    Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux

    7.01.102

    New

    5

    Prostatic Urethral Lift

    7.01.151

    New

    6

    Allogeneic Pancreas Transplant

    7.03.02

    Minor Update

    7

    Biofeedback as a Treatment of Urinary Incontinence in Adults

    2.01.27

    Minor Update

    8

    Digital Health Technologies for Attention Deficit/Hyperactivity Disorder

    3.03.03

    Minor Update

    9

    Digital Health Technologies: Diagnostic Applications

    3.03.01

    Minor Update

    10

    Facet Joint Denervation

    7.01.116

    Archived

    11

    Gender Affirmation Surgery

    BSC7.02

    Admin Coding

    12

    Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer

    2.04.61

    Minor Update

    13

    Gene Expression Profiling for Cutaneous Melanoma

    2.04.146

    Archived

    14

    Genetic Testing for Macular Degeneration

    2.04.103

    Archived

    15

    Germline Genetic Testing for Gene Variants Associated With Breast Cancer in Individuals at High Breast Cancer Risk (CHEK2, ATM, and BARD1) 

    2.04.126

    Minor Update

    16

    Germline Genetic Testing for Hereditary Diffuse Gastric Cancer (CDH1, CTNNA1)

    2.04.154

    Minor Update

    17

    Germline Genetic Testing for Ovarian Cancer Risk (BRIP1, RAD51C, RAD51D, NBN)

    2.04.149

    Minor Update

    18

    Heart Transplant

    7.03.09

    Minor Update

    19

    Heart/Lung Transplant

    7.03.08

    Minor Update

    20

    Hip Arthroplasty for Adults

    BSC7.11

    Minor Update

    21

    Isolated Small Bowel Transplant

    7.03.04

    Minor Update

    22

    Kidney Transplant

    7.03.01

    Minor Update

    23

    Liver Transplant and Combined Liver-Kidney Transplant

    7.03.06

    Minor Update

    24

    Lung and Lobar Lung Transplant

    7.03.07 

    Minor Update

    25

    Lung Volume Reduction Surgery for Severe Emphysema

    7.01.71

    Minor Update

    26

    Magnetoencephalography/Magnetic Source Imaging

    BSC6.05

    Minor Update

    27

    Medical Cannabis for the Treatment of Pain and Spasticity

    5.01.32

    Archived

    28

    Non-Invasive Positive Airway Pressure for Chronic Obstructive Pulmonary Disease

    8.01.64

    Minor Update

    29

    Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence

    1.01.17

    Minor Update

    30

    Remote Electrical Neuromodulation for Migraine

    7.01.171

    Minor Update

    31

    Reproductive Techniques

    4.02.04

    Minor Update

    32

    Small Bowel/Liver and Multivisceral Transplant

    7.03.05

    Minor Update

    33

    Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation

    7.01.172

    Minor Update

    34

    Total Artificial Hearts and Implantable Ventricular Assist Devices

    7.03.11

    Minor Update

    35

    Uterus Transplantation for Absolute Uterine Factor Infertility

    4.02.06

    Minor Update

    36

    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 September 1, 2023

     

    Policy Title –September 1, 2023

    Policy#

    Status

    1

    Oncology: Molecular Analysis Of Solid Tumors And Hematologic Malignancies

    BSC_CON_2.04

    Major Update

    2

    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure

    1.01.02

    New

    3

    Electromagnetic Navigational Bronchoscopy

    7.01.122

    New

    4

    Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

    2.03.07

    New

    5

    Multicancer Early Detection Testing

    2.04.158

    New

    6

    Neurofeedback

    2.01.28

    New

    7

    Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy

    7.01.29

    New

    8

    Proteogenomic Testing for Patients With Cancer

    2.04.140

    New

    9

    Risk-Reducing Mastectomy

    7.01.09

    New

    10

    Tumor Treating Fields Therapy

    1.01.29

    New

    11

    Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds

    8.01.14

    Minor Update

    12

    Cellular Immunotherapy for Prostate Cancer

    8.01.53

    Minor Update

    13

    Continuous Glucose Monitoring

    1.01.20

    Admin Coding

    14

    Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone

    7.01.92

    Minor Update

    15

    Elective Invasive Coronary Angiography (ICA)

    BSC2.13

    Minor Update

    16

    Elective Percutaneous Coronary Intervention (PCI)

    BSC6.02

    Minor Update

    17

    Electronic Brachytherapy for Nonmelanoma Skin Cancer

    8.01.62

    Minor Update

    18

    Endobronchial Brachytherapy

    8.03.11

    Minor Update

    19

    Genetic Testing for Diagnosis and Management of Mental Health Conditions

    2.04.110

    Minor Update

    20

    Genotype-Guided Tamoxifen Treatment

    2.04.51

    Minor Update

    21

    Intensity-Modulated Radiotherapy of the Breast and Lung

    8.01.46

    Admin Coding

    22

    Intensity-Modulated Radiotherapy of the Prostate

    8.01.47

    Admin Coding

    23

    Intensity-Modulated Radiotherapy: Abdomen, Pelvis and Chest

    8.01.49

    Admin Coding

    24

    Intensity-Modulated Radiotherapy: Cancer of the Head and Neck or Thyroid

    8.01.48

    Admin Coding

    25

    Intensity-Modulated Radiotherapy: Central Nervous System Tumors

    8.01.59

    Admin Coding

    26

    Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain

    8.01.45

    Minor Update

    27

    Intraoperative Radiotherapy

    8.01.08

    Minor Update

    28

    Magnetic Resonance-Guided Focused Ultrasound

    7.01.109

    Minor Update

    29

    Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus

    8.01.06

    Minor Update

    30

    Radioembolization for Primary and Metastatic Tumors of the Liver

    8.01.43

    Minor Update

    31

    Radiofrequency Ablation of Primary or Metastatic Liver Tumors

    7.01.91

    Minor Update

    32

    Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer

    7.01.121

    Minor Update

    33

    Serologic Genetic and Molecular Screening for Colorectal Cancer

    2.04.150

    Minor Update

    34

    Stereotactic Radiosurgery and Stereotactic Body Radiotherapy

    6.01.10

    Admin Coding

    35

    Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies

    8.01.11

    Minor Update

    36

    Treatment of Varicose Veins/Venous Insufficiency

    7.01.124

    Admin Coding

    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, 2023

     

    Policy Title –August 1, 2023

    Policy#

    Status

    1

    Cytochrome P450 Genotype-Guided Treatment Strategy

    2.04.38

    Major Update

    2

    Autonomic Nervous System Testing

    2.01.96

    New

    3

    Closure Devices for Patent Foramen Ovale and Atrial Septal Defects

    2.02.09

    New

    4

    Electromyography and Nerve Conduction Studies

    2.01.95

    New

    5

    Endovascular Stent Grafts for Abdominal Aortic Aneurysms

    7.01.67

    New

    6

    Gene Expression Profiling for Cutaneous Melanoma          

    2.04.146    

    New

    7

    Genetic Testing for Alpha Thalassemia

    2.04.104

    New

    8

    Genetic Testing for Rett Syndrome

    2.04.81

    New

    9

    Home Cardiorespiratory Monitoring

    1.01.06

    New

    10

    Low Level Laser Therapy

    2.01.56

    New

    11

    Oncology: Algorithmic (Genetic Expression) Testing

    BSC_CON_2.05

    New

    12

    Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation

    2.02.26

    New

    13

    Polysomnography for Non-Respiratory Sleep Disorders

    2.01.99

    New

    14

    Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia

    2.02.18

    New

    15

    Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases

    2.04.123

    New

    16

    Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy

    2.01.49

    New

    17

    Actigraphy

    2.01.73

    Minor Update

    18

    Amniotic Membrane and Amniotic Fluid

    7.01.149

    Admin Coding

    19

    Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer

    2.04.36

    Archived

    20

    Autologous Platelet-Derived Growth Factors for Wound Healing and Other Non-Orthopedic Conditions

    2.01.16

    Admin Coding

    21

    Bariatric Surgery

    7.01.47

    Minor Update

    22

    Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure

    2.02.10

    Admin Coding

    23

    Bronchial Thermoplasty

    7.01.127

    Minor Update

    24

    Bronchial Valves

    7.01.128

    Minor Update

    25

    Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting

    2.02.24

    Minor Update

    26

    Cardiovascular Risk Panels

    2.04.100

    Admin Coding

    27

    Cognitive Rehabilitation

    8.03.10

    Admin Coding

    28

    Diagnosis of Obstructive Sleep Apnea Syndrome