C50.919 Insurance Policy Changes

ICD-10 C50.919 is officially defined as "Malignant neoplasm of unspecified site of unspecified female breast." code C50.919 is referenced in 5 tracked payer policy changes from Healthfirst, 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 C50.919 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Healthfirst · Effective Apr 1, 2026High impact
NYS Medicaid Breast Cancer Selective Program Reimbursement Policy
Healthfirst's NYS Medicaid Breast Cancer Selective Program policy (PO-RE-168v1) requires prior authorization for all breast cancer surgical procedures under the program, and those procedures must be performed at NYS-approved facilities. Services rendered at restricted facilities are not eligible for reimbursement, and authorization requests listing a restricted facility will be denied. The policy applies only when a qualifying diagnosis code from Appendix A is linked to a qualifying procedure code, and Appendix A states the Medicaid breast cancer service exclusion is effective April 1, 2025.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02
Excellus medical policy 7.02.02 sets when allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered medically appropriate. It applies when the candidate meets the transplanting institution's selection criteria, the multidisciplinary team evaluates the individual and recommends treatment, and the individual is treated for one of the listed indications. The listed indications include acute and chronic leukemias, non-Hodgkin lymphoma, myelodysplastic diseases at intermediate or high risk, sickle cell anemia under stated criteria, transfusion-dependent thalassemia, bone marrow failure syndromes, severe combined immunodeficiency, hemophagocytic disorders, several storage and leukodystrophy disorders, and certain skeletal and metabolic bone disorders. Allo-HSCT is considered investigational for all other indications. The February 19, 2026 revision simplified the criteria to the indication level, removed the investigational indications list and added HCPCS code S2142.
Aetna · Identified Aug 16, 2026Medium impact
External Breast Prosthesis (CPB 0097, reviewed 2026-01-15)
External breast prostheses are medically necessary following a medically necessary mastectomy or lumpectomy and for persons with gender dysphoria, with up to six breast prosthesis bras initially after a medically necessary mastectomy and up to six bra replacements every 12 months. One breast prosthesis per side is covered for the useful lifetime of the prosthesis, two prostheses (one per side) are covered for bilateral mastectomy or gender dysphoria, and one replacement silicone breast prosthesis is covered every 24 months. A breast prosthesis with integrated adhesive, a custom-fabricated prosthesis compared with a pre-fabricated silicone prosthesis, a prosthesis for developmental breast asymmetry, and more than one external breast prosthesis are considered not medically necessary.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)
Quantitative sensory testing (QST), current perception threshold (CPT) testing, voltage-actuated sensory nerve conduction threshold (VsNCT) testing, and quantitative thermal testing for early diagnosis of leprosy are considered experimental, investigational, or unproven for the uses listed in this policy, because their effectiveness or clinical value has not been established. Listed uses include evaluating fibromyalgia pain, chronic itch, chronic pelvic pain, and shoulder pain, and diagnosing restless legs syndrome and small fiber neuropathy in postural orthostatic tachycardia syndrome. CPT codes 0106T through 0110T and HCPCS code G0255 are not covered for the listed indications.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Estrogen Hormone Testing: Estradiol and Estrone
Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism, to diagnose hyperestrogenism in symptomatic males, to monitor hormone replacement therapy in postmenopausal females, and to monitor antiestrogen therapy. Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients. The covered tests are total estradiol (CPT 82670), fractionated estrogens (CPT 82671), total estrogens (CPT 82672), estrone (CPT 82679), and free estradiol by direct measurement, such as equilibrium dialysis (CPT 82681).

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C50.919?

There are 5 tracked policy changes affecting code C50.919, including updates from Healthfirst, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C50.919?

Payers that have issued tracked updates for code C50.919 include: Healthfirst, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C50.919 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C50.919. 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 C50.919?

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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NYS Medicaid Breast Cancer Selective Program Reimbursement Policy

Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02

External Breast Prosthesis (CPB 0097, reviewed 2026-01-15)

Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)

Estrogen Hormone Testing: Estradiol and Estrone

What insurance policy changes affect code C50.919?

Which payers have updated policy for code C50.919?

How do I get notified when code C50.919 policy changes?

Why do payers change policies for code C50.919?