Home
Billing codes
C50.A1

PAYER POLICY CHANGES

C50.A1 Insurance Policy Changes

ICD-10 C50.A1 is officially defined as "Malignant inflammatory neoplasm of right breast." code C50.A1 is referenced in 42 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, Medicare/CMS - Transmittals, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C50.A1 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 Nov 10, 2026High impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota has revised its commercial prior authorization medical drug policies for drugs including Avlayah, bendamustine, bevacizumab, denosumab, omalizumab, Pluvicto and Sarclisa, with revisions effective November 10, 2026. Several HCPCS changes are effective October 1, 2026, including HCPCS codes J1757, J9066 and Q5173, and J3590 is discontinued for Avlayah, Ponlimsi and denosumab-adet on that date. The updates also add the number of days allowed to the Length of Authorization sections, replace specific contraindications in Universal Criteria with general FDA contraindication language, and add ICD-10 codes including C83.36 and C50.A0 through C50.A2.
Blue Cross Blue Shield of North Dakota · Effective Oct 1, 2026High impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota's August 2026 pharmacy update covers Medicaid Expansion medical drug prior authorization policies, with new policies and coding changes effective October 1, 2026. The most important billing change is the new HCPCS codes that replace older codes, such as Q5172 for Filkri and J9362 for Yondelis, plus added diagnosis codes for several drugs; the commercial pharmacy policies were reviewed with no changes listed.
Medicare/CMS - Transmittals · Effective Jul 6, 2026High impact
R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197
CMS updated Chapters 3, 13, 17, 18 and 32 of the Medicare Claims Processing Manual to match National Coverage Determination updates for ICD-10 and other coding revisions. The updated sections are effective July 6, 2026. Several code changes apply to services on or after October 1, 2025, including new ICD-10 diagnosis codes for mammography, Pap smears, PET, colorectal cancer screening and chronic ulcer wound treatment, and coverage for HCPCS codes J0738 and J0752 for PrEP.
Blue Cross Blue Shield of Rhode Island · Effective Feb 1, 2026High impact
Medical policy updates
Multiple medical policies are being updated with changes to prior authorization requirements, covered diagnosis codes, and billing procedures across various specialties. Key changes include removal of prior authorization for several CPT codes, addition of new ICD-10 codes for breast cancer-related services, and updates to genetic testing coverage criteria.
Independence Blue Cross · Effective Dec 29, 2025High impact
08.01.33l, Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross updated Leuprolide policy 08.01.33l to version 08.01.33n, adding coverage for uterine neoplasms, revising prostate cancer and head/neck cancer criteria per NCCN guidelines, and introducing Camcevi ETM 21 mg (3-month formulation). Specific ICD-10 codes for inflammatory breast cancer and uterine malignancies were added or modified with different coverage rules by formulation. The preferred product designation remains leuprolide acetate (Eligard/Lupron Depot J9217) for prostate cancer and salivary gland tumors, with nonpreferred products (Camcevi, Camcevi ETM, Lupron Depot J1950) covered only for current/prior users or those with contraindications/intolerances.
Independence Blue Cross · Effective Oct 1, 2025High impact
MA00.003ae, Preventive Care Services
Independence Blue Cross Medicare Advantage policy MA00.003ah (effective 10/01/2025) updates preventive care coverage codes and criteria across multiple screening services. Key changes include: colorectal cancer screening now covers CT colonography and Cologuard Plus/Shield (removes barium enema); new HIV prevention drug lenacapavir (Yeztugo) added; updated ICD-10 and HCPCS codes for colorectal, mammography, pelvic exam, and AAA screening services. Billing teams must update systems to reflect deleted and added codes to avoid claim denials.
Independence Blue Cross · Effective Oct 1, 2025High impact
MA00.003ae, Preventive Care Services
Independence Blue Cross updated MA00.003ae to MA00.003ah, effective October 1, 2025, adding new preventive services (CT colonography, Cologuard Plus, Shield, lenacapavir/Yeztugo for HIV PrEP) and removing barium enema screening. Multiple ICD-10 and HCPCS codes were added or revised across colorectal cancer screening, mammography, pelvic exams, AAA screening, and HIV prevention coverage.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
Lupron (leuprolide acetate)
Prior authorization is required for Lupron (leuprolide). The 08/01/2026 revision adds medically necessary coverage for Eligard (leuprolide acetate) and leuprolide acetate depot for advanced prostate cancer, and it lists Camcevi (leuprolide), Lutrate Depot (leuprolide acetate kit), Vabrinty (leuprolide acetate) and Fensolvi (leuprolide acetate) as not covered on any BCBSMS Formulary. Lupron may be considered medically necessary for endometriosis, uterine leiomyomata, central precocious puberty, or prostate cancer when the initial criteria for that indication are documented.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early-Stage Breast Cancer
Accelerated partial breast irradiation (APBI), including 3D conformal radiation therapy, intensity modulated radiation therapy, or multicatheter brachytherapy, may be considered medically necessary for individuals who have age at least 40, ER-positive histology, grade 1-2 disease, a tumor 2 cm or less, negative lymph nodes, negative surgical margins, and no known germline pathogenic or likely pathogenic BRCA 1 or BRCA 2 variant. The 08/25/2025 policy review changed APBI from investigational to medically necessary for these individuals. Accelerated whole-breast irradiation may be considered medically necessary for invasive carcinoma with tumors 5 cm or less, negative lymph nodes, technically clear surgical margins, and age at least 50, and it is investigational in all other situations involving early-stage breast cancer after breast-conserving surgery.
Independence Blue Cross · Effective Nov 2, 2026Medium impact
MA08.129c, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
Independence Blue Cross updated Medicare Advantage policy MA08.129c effective 11/02/2026 to align with FDA labeling for Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf). The policy added 38 specific ICD-10 breast cancer diagnosis codes (C50.011 through C50.922 and C50.A1–C50.A2) to the list of covered diagnoses. Coverage remains conditioned on HER2-positive status confirmed by FDA-approved diagnostic testing, specific LVEF thresholds, and one of three treatment settings (neoadjuvant, adjuvant, or metastatic with docetaxel).
Independence Blue Cross · Effective Nov 2, 2026Medium impact
08.01.72c, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
Independence Blue Cross updated its commercial medical policy for Phesgo (pertuzumab, trastuzumab and hyaluronidase-zzxf, HCPCS J9316) to match FDA labeling, and the policy text states it became effective November 2, 2026, which has already passed. It adds 38 breast cancer ICD-10 codes (C50 series) to the list of diagnoses the policy covers, and it limits coverage to listed HER2-positive breast cancer uses with set heart function (LVEF) thresholds and confirmed HER2 test results.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Germline Genetic Testing for Hereditary Diffuse Gastric Cancer (CDH1, CTNNA1)
Germline CDH1 testing for hereditary diffuse gastric cancer may be considered medically necessary when individuals meet listed criteria, such as a diagnosis of diffuse gastric cancer before age 50, a diagnosis of diffuse gastric cancer at any age in individuals of Maori ethnicity or with a personal or family history of cleft lip/palate, or a diagnosis of bilateral lobular breast cancer before age 70. CDH1 testing for individuals who do not meet these criteria, and CTNNA1 testing, are considered investigational. The code reference section was updated on 10/01/2026 to add ICD-10 diagnosis code QA1.71.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2)
Genetic testing for BRCA1, BRCA2 and PALB2 variants may be considered medically necessary in individuals with cancer who meet listed criteria, such as a personal history of breast cancer diagnosed at age 45 years or younger, a personal history of epithelial ovarian carcinoma at any age, or a personal history of exocrine pancreatic cancer at any age. Testing of BRCA1 and BRCA2 in individuals with a family history of cancer who do not meet the criteria, testing of PALB2 in individuals who do not meet the criteria, and genetic testing in minors are considered investigational. The code reference section was updated on 10/01/2026 to add ICD-10 diagnosis codes QA1.790 and QA1.791 and to remove deleted CPT code 96040.
Excellus BlueCross BlueShield · Effective Aug 20, 2026Medium impact
Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy 10.01.01
Excellus policy 10.01.01 considers reconstructive breast surgery during or after mastectomy, including partial mastectomy for benign or malignant disease, medically appropriate. Covered services may include breast implants, abdominal flap reconstruction, chest wall reconstruction, nipple and areola reconstruction and tattooing, surgery for symmetry of the opposite breast, basic breast prostheses, mastectomy bras, and treatment of physical complications of mastectomy including lymphedema. A risk-reducing mastectomy is considered medically appropriate for individuals with lobular carcinoma in situ, a known BRCA1 or BRCA2 variant, another high-risk gene variant, or chest radiotherapy between ages 10 and 30, and the 08/20/26 annual review states that policy intent is unchanged.
Independence Blue Cross · Effective Mar 23, 2026Medium impact
MA08.072p, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Independence Blue Cross updated MA08.072p to revise medical necessity criteria for bevacizumab and biosimilars across 11 cancer indications, aligning with current FDA labeling and NCCN guidelines. Three new ICD-10 codes were added (including inflammatory breast cancer and HER2 negative status), four uncertain behavior ovarian codes were removed, and a new HCPCS code Q5160 (bevacizumab-nwgd/Jobevne) was added to the covered biosimilar portfolio.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
MA08.083l, Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross updated MA08.083l to MA08.083n effective 12/29/2025, adding coverage for uterine neoplasms, revising prostate cancer and head/neck cancer criteria per NCCN guidelines, adding the new Camcevi ETM 21 mg 3-month formulation, and modifying ICD-10 code coverage to specify laterality for breast inflammatory neoplasms. The preferred product designation remains leuprolide acetate (Eligard and Lupron Depot 7.5 mg, J9217) for prostate cancer and salivary gland tumors.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Zoladex (goserelin)
The Zoladex (goserelin) policy added ICD-10 diagnosis codes C50.A0, C50.A1 and C50.A2 for malignant inflammatory neoplasm of breast, effective 10/01/2025. Prior authorization is required, and the use of samples is not considered current or stable therapy. Medically necessary criteria include individuals aged 18 or older with advanced breast cancer in pre- or perimenopausal women with hormone-receptor positive breast cancer, prostate cancer, endometriosis, or endometrial thinning before endometrial ablation, with approval lengths of 12 months for breast and prostate cancer, 6 months for endometriosis and 2 months for endometrial thinning.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
State and School Employees' Health Insurance Plan - Zoladex (goserelin)
Zoladex (goserelin) may be considered medically necessary for adults 18 years of age or older with advanced breast cancer in pre- or perimenopausal women with hormone-receptor positive disease, for prostate cancer that is T2b-T4 (stage B2-C) used with flutamide or advanced prostate cancer, for endometriosis, and for endometrial thinning before endometrial ablation. Approval lengths are 12 months for breast cancer and prostate cancer, 6 months for endometriosis and 2 months for endometrial thinning, and use for endometriosis beyond 6 months is considered investigational and will not be approved. The code reference section was updated on 10/01/2025 to add ICD-10 diagnosis codes C50.A0, C50.A1 and C50.A2 for malignant inflammatory neoplasm of breast.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Intensity-Modulated Radiotherapy (IMRT): Breast and Lung
Intensity-modulated radiotherapy (IMRT) for breast cancer may be considered medically necessary to deliver whole-breast irradiation in individuals with left-sided breast cancer after breast-conserving surgery when significant cardiac radiation exposure cannot be avoided with alternative radiotherapy and IMRT dosimetry shows significantly reduced cardiac target volume exposure. IMRT may also be considered medically necessary for individuals with large breasts when 3D conformal radiotherapy produces hot spots greater than 10% of target dose that IMRT can avoid. IMRT for lung cancer may be considered medically necessary when radiotherapy is given with curative intent, 3D conformal radiotherapy would expose more than 35% of normal lung tissue to more than 20 Gy (V20), and IMRT reduces the V20 to at least 10% below the 3D plan; partial-breast IMRT, chest wall IMRT after mastectomy and palliative lung IMRT are investigational. A 10/01/2025 update added ICD-10 codes C50.A0, C50.A1 and C50.A2 for malignant inflammatory neoplasm of breast.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Immunohistochemistry for Microscopic Evaluation of Breast Cancer
IHC stains for estrogen receptor (ER), progesterone receptor (PR) and Her2 may be considered medically necessary in all primary invasive breast cancers when billed with CPT codes 88342 and 88341 x 2, 88360 x 3, or 88361 x 3. For ductal in-situ breast cancer, an ER stain may be considered medically necessary, a PR stain only when an ER stain was performed and was negative, and a Her2 stain is not medically necessary. IHC stains performed as reflex templates or pre-orders before the pathologist reviews routine H&E stains, or without clinical evidence that the stain is actionable, are considered not medically necessary. A 10/01/2025 update added ICD-10 codes C50.A0, C50.A1 and C50.A2 for malignant inflammatory neoplasm of breast.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Breast Cancer (BRCA1, BRCA2, PIK3CA, Ki-67, RET, BRAF, ESR1, NTRK)
Germline BRCA1 or BRCA2 testing may be considered medically necessary to predict treatment response to PARP inhibitors such as olaparib and talazoparib in HER2-negative metastatic and early stage, high-risk breast cancer, and PIK3CA testing may be considered medically necessary to predict response to alpelisib in individuals with HR-positive, HER2-negative advanced or metastatic breast cancer who have progressed on or after an endocrine-based regimen. ESR1 testing using Guardant360 CDx may be considered medically necessary to predict response to elacestrant, and NTRK gene fusion testing may be considered medically necessary for individuals with recurrent unresectable or stage IV breast cancer. Ki-67, RET, BRAF and circulating tumor cell testing are considered investigational, and the code reference section was updated on 10/01/2025 to add ICD-10 diagnosis codes C50.A0, C50.A1 and C50.A2.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Digital Breast Tomosynthesis
Screening digital breast tomosynthesis (CPT 77063) is covered once per calendar year as an alternative to standard 2D mammography for women beginning at age 35, as part of the Healthy You! Wellness benefit, effective 01/01/2018. Digital breast tomosynthesis may be considered medically necessary as an alternative to standard 2D mammography for further imaging when used for breast cancer diagnostic purposes. Already effective 2025-10-01: ICD-10 diagnosis codes C50.A0, C50.A1 and C50.A2 for malignant neoplasm of breast were added to the code reference.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA08.083k, Leuprolide Acetate (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross updated MA08.083k to MA08.083n effective October 1, 2025, adding three inflammatory breast cancer ICD-10 codes (C50.A0, C50.A1, C50.A2) as medically necessary for leuprolide acetate 3.75mg (J1950) and 7.5mg (J9217) formulations, but explicitly NOT medically necessary for Fensolvi (J1951) and Camcevi (J1952). This creates differential coverage based on diagnosis and product selection.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross updated MA11.077i to MA11.077j, adding nine new ICD-10 diagnosis codes effective 10/01/2025 to support coding for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures. The policy itself was reissued on 04/01/2026 to reaffirm the Company's continuing coverage position; no changes to medical necessity criteria or procedure coverage occurred.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross updated MA11.077i to MA11.077j, adding nine new ICD-10 diagnosis codes (effective 10/01/2025) related to inflammatory breast cancer, fallopian tube conditions, and prophylactic surgery encounters. The policy reissued on 04/01/2026 to reaffirm the Company's continuing position on prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy coverage criteria without substantive changes to medical necessity standards.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
08.01.33k, Leuprolide Acetate (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)
Effective 10/01/2025, Independence Blue Cross has added three ICD-10 codes (C50.A0, C50.A1, C50.A2) for inflammatory breast cancer as medically necessary for leuprolide acetate products J1950 and J9217, but NOT for Fensolvi (J1951) and Camcevi (J1952). This expands coverage eligibility for these specific formulations when treating inflammatory breast cancer and may affect prior authorization workflows for nonpreferred products in this indication.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross has reissued policy 11.08.19s (now version 11.08.19t) for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy with updated ICD-10 codes effective 10/01/2025. Nine new diagnosis codes have been added to support coverage determinations, including codes for inflammatory breast cancer, genetic susceptibility to fallopian tube malignancy, and family/personal history of fallopian tube cancer. The coverage criteria and medical necessity standards remain unchanged from the prior version.
Aetna · Identified Aug 18, 2026Medium impact
Testosterone Enanthate Injection (CPB 1015, reviewed 2026-07-17)
Aetna's clinical policy for intramuscular testosterone enanthate injection (generic Delatestryl) covers it for commercial medical plans when it is medically necessary for hormone-responsive breast cancer in a premenopausal member who has benefited from oophorectomy, delayed puberty, gender dysphoria when prescribed for gender-affirming care, inoperable metastatic breast cancer in a member 1 to 5 years postmenopausal with an incomplete response to other therapy, or primary or hypogonadotropic hypogonadism with at least two confirmed low morning testosterone levels before therapy. Aetna considers age-related or late-onset hypogonadism, female sexual dysfunction or hypoactive sexual desire disorder, heart failure, and improvement of cognitive function in aging men experimental, investigational, or unproven. The brand Delatestryl has been discontinued in the U.S., and an FDA-approved generic equivalent is available.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Oncologic Applications of Positron Emission Tomography (PET) Scanning
FDG-PET or FDG-PET/CT may be considered medically necessary for listed cancers when specific criteria are met, such as staging or restaging of muscle-invasive bladder cancer, Ewing sarcoma and osteosarcoma, brain cancer, lymphoma, and multiple myeloma. PET for surveillance, meaning scans performed more than 6 months after completion of cancer therapy (12 months for lymphoma) in individuals without objective signs or symptoms of recurrence, is considered investigational, and fluoroestradiol F18 PET in individuals with breast cancer is considered investigational. The medically necessary situations assume that the PET results will influence treatment decisions, and if the results will not influence treatment decisions, those situations are considered not medically necessary.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Breast Reconstruction Following Mastectomy
Breast reconstruction is covered when it is elected in connection with a medically necessary mastectomy, in accordance with the Women's Health and Cancer Rights Act of 1998. Covered services are reconstruction of the breast on which the mastectomy was performed, surgery on the unaffected breast required to produce a symmetrical appearance, and prostheses and treatment of complications of any state of a mastectomy, including lymphedema. The policy history records a 10/01/2025 code reference update that added ICD-10 diagnosis codes C50.A0, C50.A1 and C50.A2 for malignant inflammatory neoplasm of breast.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Scintimammography and Gamma Imaging of the Breast and Axilla
From the 2026-02-12 review of Blue Cross Blue Shield's scintimammography and gamma imaging policy, which left the policy statements unchanged and states that the lymphoscintigraphy coverage statement is not applicable to other conditions. Scintimammography, breast-specific gamma imaging and molecular breast imaging are considered investigational in all applications, including as an adjunct to mammography or in staging the axillary lymph nodes. Radiopharmaceutical administration and gamma detection for localization of sentinel lymph nodes in individuals with breast cancer may be considered medically necessary.
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).
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Augmentation Mammoplasty
This Blue Cross Blue Shield policy states that benefits are specifically excluded when augmentation mammoplasty is performed for cosmetic purposes. Augmentation may be considered reconstructive in listed situations, including agenesis or severe hypoplasia with a 50% or greater deformity of the contralateral breast, scoliosis, Poland's syndrome, chest wall deformity such as pectus excavatum, breasts damaged by infection, traumatic loss, scarring, burns or X-ray therapy, and reconstruction after mastectomy for cancer. The 03/27/2026 policy update removed the ICD-9 procedure and diagnosis codes.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Bioengineered Skin and Soft Tissue Substitutes
Several listed tissue-engineered skin substitutes may be considered medically necessary for specific uses, including breast reconstruction with listed acellular dermal matrix products, chronic noninfected full-thickness diabetic lower-extremity ulcers, chronic venous insufficiency ulcers that have not adequately responded to a 1-month period of conventional ulcer therapy, dystrophic epidermolysis bullosa, and second- and third-degree burns. All other uses of the listed products, and all other skin and soft tissue substitutes not listed, are considered investigational. Code reference updates dated 07/01/2026, 08/15/2026 and 10/01/2026 add CPT 1045T through 1049T, HCPCS C9353 and C9361, and HCPCS A2046, A2047, A2048 and A2050 as investigational codes.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Low impact
Tattooing
BCBS Mississippi updated their tattooing policy to add new ICD-10 diagnosis codes C50.A0, C50.A1, and C50.A2 for malignant inflammatory neoplasm of breast, effective October 1, 2025. These codes can now be used to support coverage for medically necessary tattooing procedures related to breast reconstruction.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA11.076h, Removal of Breast Implants
Independence Blue Cross updated MA11.076h to add three new ICD-10 diagnosis codes (C50.A0, C50.A1, C50.A2) for malignant inflammatory neoplasm of breast, effective October 1, 2025. The policy was reissued on April 29, 2026 to communicate the company's continuing position on breast implant removal coverage. No changes were made to covered indications, billing codes, or coverage criteria.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA05.033e, External Breast Prostheses
Independence Blue Cross (IBX) Medicare Advantage has reissued policy MA05.033e as MA05.033f, adding two new ICD-10 diagnosis codes (C50.A1 and C50.A2 for malignant inflammatory neoplasm of breast) to the list of qualifying diagnoses for external breast prosthesis coverage. The coverage intent and medical necessity criteria remain unchanged; this is primarily a code expansion to align with current Medicare guidelines.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA11.076h, Removal of Breast Implants
Independence Blue Cross Medicare Advantage policy MA11.076h was reissued on 04/29/2026 with the addition of three new ICD-10 diagnosis codes (C50.A0, C50.A1, C50.A2) for malignant inflammatory neoplasm of breast, effective 10/01/2025. The policy's core coverage criteria for breast implant removal remain unchanged; this is primarily a code update to align with current coding standards.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA05.033e, External Breast Prostheses
Independence Blue Cross updated MA05.033e to MA05.033f, adding two new ICD-10 diagnosis codes (C50.A1 and C50.A2 for malignant inflammatory neoplasms of breast) to the covered diagnoses for external breast prostheses. The policy intent and coverage criteria remain unchanged; this is a routine annual review update with retroactive effective date.
Independence Blue Cross · Effective Oct 1, 2025Low impact
11.08.14p, Removal of Breast Implants
Independence Blue Cross reissued policy 11.08.14p with no substantive coverage changes, but added three new ICD-10 codes (C50.A0, C50.A1, C50.A2) for malignant inflammatory neoplasm of breast effective 10/01/2025. Billing teams must update coding systems to recognize these diagnoses as medically necessary indicators for breast implant removal coverage.
Independence Blue Cross · Effective Oct 1, 2025Low impact
11.08.14p, Removal of Breast Implants
Independence Blue Cross reissued Policy 11.08.14p on breast implant removal with no substantive coverage changes. Three new ICD-10 codes for malignant inflammatory neoplasm of breast (C50.A0, C50.A1, C50.A2) were added effective 10/01/2025 to align with annual code updates. Billing teams should verify these codes are loaded in systems for accurate claims processing on breast cancer cases involving implant removal.
Independence Blue Cross · Effective Oct 1, 2025Low impact
11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross reissued policy 11.08.19s on 04/01/2026 to reaffirm coverage for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy in high-risk and moderately increased-risk individuals. Nine new ICD-10 diagnosis codes were added effective 10/01/2025 to support claims related to inflammatory breast cancer, genetic susceptibility to fallopian tube malignancies, and family/personal history of fallopian tube neoplasms. No changes to coverage criteria, CPT codes, or billing requirements were made.

Watch C50.A1

Get one email when a payer policy names C50.A1, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C50.A1?

There are 42 tracked policy changes affecting code C50.A1, including updates from Blue Cross Blue Shield of North Dakota, Medicare/CMS - Transmittals, Blue Cross Blue Shield of Rhode Island. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C50.A1?

Payers that have issued tracked updates for code C50.A1 include: Blue Cross Blue Shield of North Dakota, Medicare/CMS - Transmittals, Blue Cross Blue Shield of Rhode Island, Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna.

How do I get notified when code C50.A1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C50.A1. 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.A1?

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

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Pharmacy Policies Available Online

Pharmacy Policies Available Online

R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197

Medical policy updates

08.01.33l, Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)

MA00.003ae, Preventive Care Services

MA00.003ae, Preventive Care Services

Lupron (leuprolide acetate)

Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early-Stage Breast Cancer

MA08.129c, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)

08.01.72c, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)

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

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

Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy 10.01.01

MA08.072p, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use

MA08.083l, Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)

Zoladex (goserelin)

State and School Employees' Health Insurance Plan - Zoladex (goserelin)

Intensity-Modulated Radiotherapy (IMRT): Breast and Lung

Immunohistochemistry for Microscopic Evaluation of Breast Cancer

Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Breast Cancer (BRCA1, BRCA2, PIK3CA, Ki-67, RET, BRAF, ESR1, NTRK)

Digital Breast Tomosynthesis

MA08.083k, Leuprolide Acetate (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)

MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

08.01.33k, Leuprolide Acetate (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)

11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

Testosterone Enanthate Injection (CPB 1015, reviewed 2026-07-17)

Oncologic Applications of Positron Emission Tomography (PET) Scanning

Breast Reconstruction Following Mastectomy

Scintimammography and Gamma Imaging of the Breast and Axilla

Estrogen Hormone Testing: Estradiol and Estrone

Augmentation Mammoplasty

Bioengineered Skin and Soft Tissue Substitutes

Tattooing

MA11.076h, Removal of Breast Implants

MA05.033e, External Breast Prostheses