C41.0 Insurance Policy Changes

ICD-10 C41.0 is officially defined as "Malignant neoplasm of bones of skull and face." code C41.0 is referenced in 16 tracked payer policy changes from Independence Blue Cross, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C41.0 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 Mar 30, 2026High impact
MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Independence Blue Cross updated policy MA11.099f effective 03/30/2026, removing the strict 4-week conservative medical trial and 75% nasal obstruction documentation requirements for septoplasty and rhinoplasty/septorhinoplasty. Septoplasty now requires only documentation of an attempted medical trial (not a specific 4-week duration), and rhinoplasty/septorhinoplasty criteria were expanded to include congenital deformities as a standalone criterion. Additionally, 16 ICD-10 codes were removed and 4 new codes were added per CMS LCD A56587 updates.
Independence Blue Cross · Effective Mar 30, 2026High impact
MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Independence Blue Cross MA11.099f has been reissued with significant coverage criteria changes for septoplasty, rhinoplasty, and septorhinoplasty. Key changes include: (1) Removal of the 4-week conservative medical trial and 75% nasal obstruction threshold requirements for septoplasty—now requiring only documentation of an attempted medical trial; (2) Addition of congenital deformities as a standalone coverage criterion for rhinoplasty/septorhinoplasty; (3) Removal of 15 ICD-10 diagnosis codes and addition of 4 new codes (C4A.31, C4A.39, Z85.820, Z85.821, Z85.828) effective 03/16/2026 per CMS LCA A56587 update. These changes reduce documentation burden and expand coverage eligibility.
Excellus BlueCross BlueShield · Effective Nov 16, 2025Medium impact
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 6.01.12
Excellus BlueCross BlueShield stereotactic radiosurgery and stereotactic body radiation therapy medical policy 6.01.12 has a current effective date of November 16, 2025. Its October 16, 2025 annual review removed life expectancy criteria from the policy criteria. SRS is considered medically appropriate for specified benign, brain and neurologic indications, SBRT is considered medically appropriate for specified extracranial cancers and oligometastatic disease, and SBRT is considered not medically necessary for indications including extrahepatic bile duct cancer, gallbladder cancer and chronic pain.
Aetna · Identified Oct 10, 2026Medium impact
Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)
Aetna considers radiofrequency ablation (RFA) medically necessary for indications that include colorectal cancer liver metastases, colorectal cancer lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), malignant lung masses in persons who are not candidates for surgical intervention, solitary hepatocellular carcinoma of 5 cm or less or multinodular early-stage HCC in members who are ineligible for or decline surgical resection or transplantation, renal cell carcinoma up to 4 cm in high-risk surgical candidates or in persons with renal insufficiency or a solitary kidney, and osteoid osteoma in individuals who remain symptomatic despite NSAIDs. Aetna considers RFA experimental, investigational, or unproven for combined RFA with transarterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, combined RFA and vertebral cement augmentation for spinal metastases, endoscopic ultrasound-guided RFA for aldosterone-producing adenomas, and all other indications, including curative treatment of primary or metastatic malignant neoplasms in persons able to tolerate surgical resection, biliary obstructions or strictures, renal cysts, renal angiomyolipomas, Brunner's gland hyperplasia, and unresectable localized recurrent thyroid cancers without distant metastases.
Aetna · Identified Oct 8, 2026Medium impact
Docetaxel (CPB 0956, reviewed 2026-10-05)
For commercial medical plans, docetaxel (Beizray, Docivyx, Taxotere, or generic docetaxel) is considered medically necessary for the listed cancer indications, including breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, head and neck cancer, ovarian cancer, small cell lung cancer, and soft tissue sarcoma. Breast cancer requires the disease-status criteria stated in the policy, and continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. All other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2025-12-03)
Aetna's Clinical Policy Bulletin 0811 considers autologous or allogeneic hematopoietic stem cell transplant, both ablative and non-myeloablative, experimental, investigational, or unproven for the following adult solid tumors: bile duct (cholangiocarcinoma), breast, central nervous system tumors, cervix, colon, esophagus, fallopian tube, gallbladder, kidney, liver, lung, melanoma, nasopharynx, neuroendocrine tumors, pancreas, paranasal sinus, prostate, rectum, soft tissue sarcomas, stomach, thymus, thyroid, tumors of unknown primary origin, and uterus. Aetna considers autologous hematopoietic stem cell transplant medically necessary in young adults with primitive neuroectodermal tumors, medulloblastoma, and Ewing sarcoma family of tumors when criteria are met in CPB 0496.
Aetna · Identified Aug 17, 2026Medium impact
Myringotomy and Tympanostomy Tube (CPB 0418, reviewed 2026-06-30)
Aetna considers myringotomy and tympanostomy tube insertion medically necessary for cholesteatoma, chronic retraction of the tympanic membrane or pars flaccida, complications of otitis media such as meningitis, facial nerve paralysis, coalescent mastoiditis or brain abscess, and severe otalgia in acute otitis media. Tympanostomy tube insertion is medically necessary for otitis media with effusion lasting 3 months or longer with bilateral hearing impairment of 20 dB or worse in both ears, and for recurrent acute otitis media with more than 3 episodes in 6 months or more than 4 episodes in 12 months. Tympanostomy tube insertion is not medically necessary for a single episode of otitis media with effusion lasting less than 3 months, or for recurrent acute otitis media in children who have no middle ear effusion in either ear at the time of assessment for tube candidacy. Balloon dilation of the Eustachian tube is medically necessary for individuals 8 to 17 years of age, and for adults with chronic Eustachian tube dysfunction, when the listed criteria are met. Shim placement in the Eustachian tube is medically necessary for a patulous Eustachian tube. OtoScan laser-assisted myringotomy is considered as effective as traditional myringotomy, and the same selection criteria apply to both. Myringotomy and tympanostomy tube insertion for all other indications, soft-tissue fillers for a patulous Eustachian tube, phosphorylcholine-coated and vancomycin-coated tympanostomy tubes, the EarPopper device, balloon dilation of the Eustachian tube after an initially successful or unsuccessful balloon dilation, with tympanoplasty or other middle ear surgery, or for chronic ear disease, the Tubes Under Local Anesthesia (Tula) System, and the Hummingbird Tympanostomy Tube System are considered experimental, investigational or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Levoleucovorin (Khapzory) (CPB 0889, reviewed 2025-12-04)
Aetna Clinical Policy Bulletin 0889 covers levoleucovorin (Khapzory) for commercial medical plans, and Medicare criteria are in a separate document. Aetna considers Khapzory more costly than other levoleucovorin products and considers it medically necessary only for members with a contraindication, intolerance or ineffective response to the generic levoleucovorin equivalents, when leucovorin is not an available or appropriate option. Generic or Khapzory levoleucovorin is considered medically necessary for rescue treatment after high-dose methotrexate therapy, treatment of a folate antagonist overdose or impaired methotrexate elimination, or combination therapy with fluorouracil-based chemotherapy regimens, under the same leucovorin condition. Continuation of therapy is considered medically necessary for all members, including new members, who meet the initial criteria. The brand Fusilev has been discontinued by the manufacturer.
Aetna · Identified Aug 15, 2026Medium impact
Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)
Aetna's Clinical Policy Bulletin 0815 covers ipilimumab (Yervoy) for commercial medical plans. It considers ipilimumab medically necessary for the cancer indications listed in the policy, many of them in combination with nivolumab, and considers continued treatment medically necessary for members requesting reauthorization when there is no evidence of unacceptable toxicity or disease progression. It considers ipilimumab experimental, investigational, or unproven for indications such as glioblastoma, pancreatic cancer, and prostate cancer, and for use with bevacizumab, vemurafenib, dabrafenib, or trametinib.
Aetna · Identified Aug 15, 2026Medium impact
External Ocular Photography (CPB 0734, reviewed 2025-10-27)
Aetna covers external ocular photography (CPT 92285) to track and serially compare changes in listed eye conditions when the results may have an impact on management and clinical outcomes. It is not medically necessary only to document that an eye condition exists, and it should not be repeated when the member's condition has not changed. In some cases the service is expected to be medically necessary once yearly, and more often for certain conditions.
Aetna · Identified Aug 14, 2026Medium impact
Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans (CPB 0082, reviewed 2026-03-18)
Aetna medical plans generally exclude routine dental care. Indemnity, PPO and Managed Choice plans generally cover certain oral and maxillofacial surgery services related to the jaw or facial bones, such as surgery to alter the jaw or bite when non-surgical management cannot produce functional improvement, removal of cysts and tumors, and surgical removal of teeth that will not erupt or are impacted in the bone. Pediatric orthodontics is covered only under a pediatric oral health benefit for a severe handicapping malocclusion related to a qualifying medical condition. Bone grafts into extraction sites are considered not medically necessary, except for impacted third molar extraction sites when bony defects are clinically significant and the patient is 26 years of age or older.
Aetna · Identified Aug 13, 2026Medium impact
Dostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)
For commercial medical plan members, Aetna considers dostarlimab-gxly (Jemperli) medically necessary under its initial approval criteria for several mismatch repair deficient or microsatellite instability-high cancers, including endometrial, ampullary, breast, colorectal, esophageal, gastric, ovarian, pancreatic, small bowel and anal cancers. It also considers Jemperli in combination with pemetrexed and platinum chemotherapy for first-line metastatic nonsquamous non-small cell lung cancer without genomic aberrations. Members are not eligible when they have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Optical Coherence Tomography and Microelastography for Solid Tumors and Other Selected Indications (CPB 0886, reviewed 2026-03-03)
Aetna considers optical coherence tomography and microelastography experimental, investigational, or unproven for the listed intra-operative uses because their effectiveness has not been established. These uses include assessment of lymph nodes or tumor margins in breast conserving surgery, differentiation of pancreatic neoplastic lesions, differentiation of normal and diseased thyroid and parathyroid tissues, and solid tumor surgery including optical biopsy of lymph nodes and real-time determination of surgical margins. The policy lists CPT codes and ICD-10 codes as not covered for the indications it names.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions
Charged-particle irradiation with proton or helium ion beams may be considered medically necessary for primary therapy of uveal tract melanoma meeting the listed size and metastasis criteria, for postoperative therapy after biopsy or partial resection of skull-base chordoma, low-grade chondrosarcoma or cervical spine lesions with residual localized tumor, and for pediatric central nervous system tumors. It may also be considered medically necessary where photon-based radiotherapy cannot meet normal tissue dose-volume constraints, including curative treatment of primary or benign solid pediatric non-CNS tumors such as Ewing sarcoma, nonmetastatic primary non-small cell lung cancer, and head and neck cancers. Clinically localized prostate cancer and non-curative treatment of these pediatric tumors and non-small cell lung cancer are considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Magnetic Resonance-Guided Focused Ultrasound
Magnetic resonance-guided focused ultrasound may be considered medically necessary for pain palliation in adults with metastatic bone cancer who have failed or are not candidates for radiotherapy, and for medicine-refractory essential tremors. It is considered investigational for uterine fibroids, for other tumors such as brain, prostate, breast, and desmoid tumors, and for medication-refractory tremor dominant Parkinson disease. The policy history notes that CPT code 61715 for MRI guided focused ultrasound high intensity stereotactic intracranial ablation was effective 01/01/2025.
Aetna · Identified Nov 5, 2026Low impact
Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2026-10-29)
Aetna's Clinical Policy Bulletin 0811 (last reviewed 2026-10-29) confirms that autologous and allogeneic hematopoietic cell transplantation for most adult solid tumors is considered experimental, investigational, or unproven and not covered, with listed CPT, HCPCS, and ICD-10 codes marked as not covered for those indications. The only exceptions are young adults with primitive neuroectodermal tumors, medulloblastoma, and Ewing sarcoma family tumors, which fall under CPB 0496 criteria. The source states no specific effective date for a change; the listed effective date (02/04/2011) is the original policy date and the next review is 09/09/2027.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C41.0?

There are 16 tracked policy changes affecting code C41.0, including updates from Independence Blue Cross, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C41.0?

Payers that have issued tracked updates for code C41.0 include: Independence Blue Cross, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C41.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C41.0. 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 C41.0?

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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MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty

MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty

Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 6.01.12

Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)

Docetaxel (CPB 0956, reviewed 2026-10-05)

Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2025-12-03)

Myringotomy and Tympanostomy Tube (CPB 0418, reviewed 2026-06-30)

Levoleucovorin (Khapzory) (CPB 0889, reviewed 2025-12-04)

Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)

External Ocular Photography (CPB 0734, reviewed 2025-10-27)

Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans (CPB 0082, reviewed 2026-03-18)

Dostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)

Optical Coherence Tomography and Microelastography for Solid Tumors and Other Selected Indications (CPB 0886, reviewed 2026-03-03)

Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions

Magnetic Resonance-Guided Focused Ultrasound

Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2026-10-29)

What insurance policy changes affect code C41.0?

Which payers have updated policy for code C41.0?

How do I get notified when code C41.0 policy changes?

Why do payers change policies for code C41.0?