C06.9 Insurance Policy Changes

ICD-10 C06.9 is officially defined as "Malignant neoplasm of mouth, unspecified." code C06.9 is referenced in 6 tracked payer policy changes from Blue Cross Blue Shield of North Dakota and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C06.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross Blue Shield of North Dakota · Effective Sep 9, 2026Medium impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota updated its commercial pharmacy policies, and the revisions to the commercial prior authorization medical drug policies are effective September 9, 2026. Revisions to the commercial post service claim edit medical drug policies are effective August 1, 2026. Many of the prior authorization policies now state the number of days allowed for initial and renewal authorization durations, replace specific contraindications in the Universal Criteria with general language that the member does not have any FDA contraindications, and add covered ICD-10 diagnosis codes in Appendix 1.
Aetna · Identified Aug 17, 2026Medium impact
Mohs Micrographic Surgery (CPB 0383, reviewed 2026-05-28)
Aetna's Clinical Policy Bulletin 0383 considers Mohs micrographic surgery medically necessary for lesions in areas of important tissue preservation (ears, face, feet, hands, genitalia and perianal area), atypical fibroxanthoma, dermatofibrosarcoma protuberans, lesions 2 cm or larger or rapidly growing, lesions in high-recurrence areas, previously irradiated skin, recurrent or incompletely excised malignant lesions, squamous cell carcinomas with high risk of metastasis, superficial melanoma in situ and lentigo maligna in areas of important tissue preservation, tumors with aggressive histologic patterns, and tumors with ill-defined borders. Aetna considers Mohs surgery for all other indications experimental, investigational or unproven, including adenoid cystic carcinoma, nail unit melanoma, pilomatrix carcinoma, vulvar malignancies and deep cutaneous fungal infections. Mohs micrographic surgery requires a single physician to act as both surgeon and pathologist, and the Mohs CPT codes are inappropriate if either role is delegated to another physician who reports those services separately.
Aetna · Identified Aug 17, 2026Medium impact
Suction Pumps (CPB 0503, reviewed 2026-07-02)
Aetna considers home model respiratory suction pumps medically necessary as durable medical equipment for members who have difficulty raising and clearing secretions because of cancer or surgery of the throat or mouth, dysfunction of the swallowing muscles, a tracheostomy, or unconsciousness or an obtunded state. Gastric suction pumps are medically necessary for members who are unable to empty gastric secretions through normal gastrointestinal functions. Wound suction is considered medically necessary only when the quantity of exudate exceeds the capacity of conservative measures such as surgical dressings and wound fillers to contain it. Aetna considers subcutaneous peritoneal ascites pumps such as the alfa-pump System experimental, investigational, or unproven for managing ascites and for the other indications the policy lists.
Aetna · Identified Aug 15, 2026Medium impact
Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)
Carbogen inhalation therapy (5% carbon dioxide and 95% oxygen) is considered experimental, investigational, or unproven for bladder cancer, central retinal artery occlusion, cervical cancer, fracture healing, head and neck cancers, optic nerve damage or degeneration, prostate cancer, retinal artery occlusion, seizures, stroke, and sudden hearing loss. The policy lists no specific CPT or HCPCS code for carbogen inhalation therapy, and the ICD-10 diagnosis codes for these indications are listed as not covered for carbogen inhalation therapy. The policy was last reviewed 07/09/2026.
Aetna · Identified Aug 15, 2026Medium impact
Carbon Dioxide Laser (CPB 0427, reviewed 2026-07-08)
Aetna's clinical policy bulletin for carbon dioxide laser (CPB 0427) lists the uses it considers medically necessary: condyloma, pelvic pain associated with endometriosis, primary penile tumors (clinical stage Tis, Ta, and T1 Grade 1 to 2), refractory plantar warts, removal of actinic keratoses for members who meet CPB 0567 criteria, removal of superficial basal cell carcinomas, and fractional carbon dioxide laser for hypertrophic burn, traumatic, and surgical scars when conventional therapies have failed. Aetna considers carbon dioxide laser experimental, investigational, or unproven for a list of other indications, including hidradenitis suppurativa, male androgenetic alopecia, onychomycosis, port wine stains, stress urinary incontinence, and vaginal atrophy. Aetna considers carbon dioxide laser treatment of other actinic lesions cosmetic.
Aetna · Identified Aug 13, 2026Medium impact
Durvalumab (Imfinzi) (CPB 0917, reviewed 2026-06-25)
Aetna considers durvalumab (Imfinzi) medically necessary for commercial medical plans when the criteria for a listed indication are met, and considers all other indications experimental, investigational, or unproven. Precertification is required of all Aetna participating providers and members in applicable plan designs, and Aetna considers members not eligible for Imfinzi when they have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy. Continuation of therapy is medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen, up to 12 months total for unresectable stage II or III NSCLC and up to 24 months total for limited stage SCLC.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C06.9?

There are 6 tracked policy changes affecting code C06.9, including updates from Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C06.9?

Payers that have issued tracked updates for code C06.9 include: Blue Cross Blue Shield of North Dakota, Aetna.

How do I get notified when code C06.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C06.9. 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 C06.9?

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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Pharmacy Policies Available Online

Mohs Micrographic Surgery (CPB 0383, reviewed 2026-05-28)

Suction Pumps (CPB 0503, reviewed 2026-07-02)

Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)

Carbon Dioxide Laser (CPB 0427, reviewed 2026-07-08)

Durvalumab (Imfinzi) (CPB 0917, reviewed 2026-06-25)

What insurance policy changes affect code C06.9?

Which payers have updated policy for code C06.9?

How do I get notified when code C06.9 policy changes?

Why do payers change policies for code C06.9?