B39.9 Insurance Policy Changes

ICD-10 B39.9 is officially defined as "Histoplasmosis, unspecified." code B39.9 is referenced in 5 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code B39.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Feb 2, 2026Medium impact
MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)
Independence Blue Cross reissued MA07.003f on 02/02/2026 with no substantive changes to photodynamic therapy coverage criteria, but removed 15 ICD-10 diagnosis codes that are no longer covered under this policy. The policy aligns with CMS National Coverage Determinations (NCDs) for verteporfin PDT treatment of choroidal neovascularization associated with AMD, presumed ocular histoplasmosis, and pathologic myopia. Billing teams must remove the deleted ICD-10 codes from claim submission logic to prevent denials.
Independence Blue Cross · Effective Nov 17, 2025Medium impact
07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Independence Blue Cross reissued Policy 07.13.05m on its existing terms with no substantive changes to PDT verteporfin coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claim submissions for certain macular degeneration and choroidal conditions. Billing teams must verify that claims use only the diagnosis codes now listed in the policy to avoid denials.
Independence Blue Cross · Effective Nov 17, 2025Medium impact
07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Independence Blue Cross reissued policy 07.13.05m on photodynamic therapy (PDT) using verteporfin with no substantive changes to coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claims processing for certain ocular conditions. Billing teams must verify that claims for PDT use only the ICD-10 codes listed in the current policy to avoid denials.
Aetna · Identified Aug 19, 2026Medium impact
Verteporfin (Visudyne) Photodynamic Therapy (CPB 0594, reviewed 2026-04-24)
Aetna's policy for commercial medical plans covers verteporfin (Visudyne) photodynamic therapy under CPT 67221 and 67225 when the criteria are met. Covered indications are predominantly classic subfoveal choroidal neovascularization from wet age-related macular degeneration, pathologic myopia, presumed ocular histoplasmosis, or chronic central serous chorioretinopathy with a treatment spot size of 6.4 mm or less in diameter, and choroidal hemangioma. Visudyne must be prescribed by or in consultation with an ophthalmologist, and continuation therapy is covered for members with a positive clinical response; combination with anti-angiogenic agents for AMD and all other indications are considered experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Photodynamic Therapy for Choroidal Neovascularization
BCBSMS considers verteporfin photodynamic therapy as monotherapy medically necessary for choroidal neovascularization associated with age-related macular degeneration, pathologic myopia, presumed ocular histoplasmosis, chronic central serous chorioretinopathy, or choroidal hemangioma. Verteporfin photodynamic therapy as monotherapy for other ophthalmologic disorders is considered investigational. Verteporfin photodynamic therapy combined with ranibizumab, bevacizumab, aflibercept, brolucizumab-dbll or faricimab-svoa is also considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code B39.9?

There are 5 tracked policy changes affecting code B39.9, including updates from Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code B39.9?

Payers that have issued tracked updates for code B39.9 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code B39.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code B39.9. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code B39.9?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)

07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)

07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)

Verteporfin (Visudyne) Photodynamic Therapy (CPB 0594, reviewed 2026-04-24)

Photodynamic Therapy for Choroidal Neovascularization

What insurance policy changes affect code B39.9?

Which payers have updated policy for code B39.9?

How do I get notified when code B39.9 policy changes?

Why do payers change policies for code B39.9?