C76.3 Insurance Policy Changes

ICD-10 C76.3 is officially defined as "Malignant neoplasm of pelvis." code C76.3 is referenced in 4 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C76.3 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 16, 2026Medium impact
Fibroid Treatment (CPB 0304, reviewed 2026-04-17)
Aetna considers radiofrequency ablation or transcatheter uterine artery embolization medically necessary as an alternative to hysterectomy or myomectomy for uterine fibroids when the member has persistent symptoms directly attributed to the fibroids, such as excessive menstrual bleeding, bulk-related pelvic pain, pressure or discomfort, urinary symptoms from compression of the ureter or bladder, or dyspareunia. Aetna considers myomectomy or hysterectomy using power morcellation experimental, investigational, or unproven, except in women without known or strongly suspected uterine cancer who meet the listed exception criteria, such as premenopausal women who wish to maintain fertility and have no risk factors for uterine sarcoma. Aetna also considers cryomyolysis, cryotherapy, electrical ablation, interstitial thermotherapy, laparoscopic uterine artery occlusion, lasers, focused ultrasound ablation, acupuncture, and other uses of transcatheter uterine artery embolization experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Transrectal Ultrasound (CPB 0001, reviewed 2026-03-05)
Aetna considers transrectal ultrasound (TRUS) medically necessary for specific conditions involving the prostate, rectum and surrounding tissues. These include clinical staging of prostate cancer and rectal carcinoma, determining prostate volume before brachytherapy, evaluation of anal or rectal fistula and peri-rectal abscesses, evaluation of hematospermia, assessment of anal sphincter dysfunction, evaluation of benign or malignant peri-rectal tumors, and infertility or azoospermia where an ejaculatory duct cyst is suspected. Metastatic lesions of unknown source with a PSA greater than 10 ng/ml that could originate in the prostate are also covered. TRUS as a screening test for prostate disease, TRUS elastography for evaluation of prostate cancer, and TRUS for cervical cancer are listed as experimental, investigational or unproven. Last review date is 03/05/2026 and next review is 01/14/2027.
Aetna · Identified Aug 14, 2026Medium impact
Double Balloon Enteroscopy (CPB 0737, reviewed 2025-11-13)
Aetna considers double balloon enteroscopy medically necessary for dilation of small bowel strictures in Crohn's disease, evaluating suspected small bowel malignancies, evaluating the colon after incomplete colonoscopy, suspected Meckel's diverticulum with an indefinite imaging work-up, obscure GI bleeding with objective evidence of recurrent bleeding, removing entrapped foreign bodies in the small bowel, removing large polyps greater than 10 mm in Peutz-Jeghers syndrome, GI bleeding when the small intestine is the source, and use with ERCP in individuals with surgically altered upper GI anatomy. Aetna considers double balloon enteroscopy experimental, investigational or unproven for other indications, including detection of small bowel neuroendocrine tumors, small bowel varices, treatment of intussusception, treatment of angioectasia (type 1 small bowel vascular lesions), and treatment of post-operative bile leakage after hepaticojejunostomy. Combined double balloon enteroscopy and endoscopic ultrasound for evaluation of Crohn's disease is also considered experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hematopoietic Cell Transplantation for Solid Tumors of Childhood
Autologous hematopoietic cell transplantation may be considered medically necessary at initial treatment of high-risk neuroblastoma and high-risk Ewing sarcoma, for recurrent or refractory neuroblastoma and Ewing sarcoma, and for metastatic retinoblastoma. Tandem autologous transplant may be considered medically necessary for high-risk neuroblastoma. Autologous transplant is considered investigational as initial treatment of low- or intermediate-risk neuroblastoma and Ewing sarcoma and for rhabdomyosarcoma, Wilms tumor, osteosarcoma and retinoblastoma without metastasis, and allogeneic transplant for pediatric solid tumors and salvage allogeneic transplant after relapse or failure of response to autologous transplant are considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C76.3?

There are 4 tracked policy changes affecting code C76.3, including updates from 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 C76.3?

Payers that have issued tracked updates for code C76.3 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C76.3 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C76.3. 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 C76.3?

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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Fibroid Treatment (CPB 0304, reviewed 2026-04-17)

Transrectal Ultrasound (CPB 0001, reviewed 2026-03-05)

Double Balloon Enteroscopy (CPB 0737, reviewed 2025-11-13)

Hematopoietic Cell Transplantation for Solid Tumors of Childhood

What insurance policy changes affect code C76.3?

Which payers have updated policy for code C76.3?

How do I get notified when code C76.3 policy changes?

Why do payers change policies for code C76.3?