C79.82 Insurance Policy Changes

ICD-10 C79.82 is officially defined as "Secondary malignant neoplasm of genital organs." code C79.82 is referenced in 13 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, 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 C79.82 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 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.
Excellus BlueCross BlueShield · Effective Aug 20, 2026Medium impact
Focal Therapies for Prostate Cancer Treatment 7.01.01
Cryosurgery and high-intensity focused ultrasound (HIFU) for recurrent prostate cancer are medically appropriate when prostate cancer has recurred after radiation therapy, as shown by a positive repeat biopsy, and there is no metastatic disease. Cryotherapy or other focal therapies, including HIFU, used for routine primary therapy for localized prostate cancer are considered investigational, as are vascular-targeted photodynamic therapy, irreversible electroporation, NanoKnife tissue ablation, laser interstitial thermal therapy, transurethral ultrasound ablation, NanoTherm magnetic field induction, and high energy water vapor thermotherapy for routine treatment. The 08/20/26 annual review kept the policy intent unchanged, and the current effective date is August 20, 2026.
Excellus BlueCross BlueShield · Effective Apr 16, 2026Medium impact
Germline Genetic Testing for Hereditary Cancers 2.02.60
Excellus BlueCross BlueShield policy 2.02.60 considers germline genetic testing for hereditary cancer medically appropriate in listed circumstances, including when a blood relative has a known pathogenic or likely pathogenic variant, when a pathogenic or likely pathogenic variant is found on tumor genomic testing, when results aid systemic therapy or surgical decisions, and when individuals meet specific criteria for breast, ovarian, pancreatic, prostate, colorectal, Cowden syndrome, Li-Fraumeni syndrome, hereditary diffuse gastric cancer or familial medullary thyroid carcinoma. Multigene panel testing is considered medically appropriate when an individual meets Policy Statement I, except Policy Statements I.A, I.D and I.G.9. The current effective date is April 16, 2026, and the annual update kept the policy intent unchanged.
Aetna · Identified Oct 5, 2026Medium impact
Transvaginal Ultrasonography (CPB 0530, reviewed 2026-08-20)
Aetna's Clinical Policy Bulletin 0530 covers transvaginal ultrasonography (CPT 76817 and 76830) when selection criteria are met. Covered indications include assessment of fetal viability and gestational age in the first trimester, assessment of pelvic masses, abnormal uterine bleeding, monitoring of follicular development during infertility therapy, ectopic pregnancy, vasa previa, suspected endometriosis, and post-menopausal bleeding. The policy considers TVUS experimental, investigational or unproven for screening for endometrial, ovarian or other gynecologic cancers and for preoperative prediction of lymph node metastasis in cervical cancer.
Healthfirst · Identified Sep 2, 2026Medium impact
Prostate Cancer Awareness Month (Sept 2026): Documentation and Coding Resources for Your Practice
Healthfirst has released updated documentation and coding guidance for prostate cancer diagnosis coding to improve accuracy and specificity. The resource provides ICD-10-CM code selection rules, documentation requirements, and examples for active treatment, surveillance, and metastatic cases to ensure proper claim submission to Healthfirst.
Aetna · Identified Aug 16, 2026Medium impact
Irreversible Electroporation (NanoKnife) (CPB 0828, reviewed 2026-03-03)
This is an older Aetna clinical policy bulletin (CPB 0828) on irreversible electroporation (IRE), including the NanoKnife system for tissue ablation. It was last reviewed 03/03/2026, and its original effective date is 06/15/2012. Aetna considers IRE experimental, investigational or unproven for all indications, including the listed indications such as hepatocellular carcinoma, pancreatic cancer, prostate cancer, renal masses, lung nodules and breast cancer, because the peer-reviewed literature has insufficient evidence.
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
Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)
Magnetic resonance spectroscopy (MRS) is considered medically necessary for specific indications in this policy, including assessing prognosis in hypoxic ischemic encephalopathy, distinguishing low grade from high grade gliomas, and distinguishing recurrent brain tumor from radiation-induced tumor necrosis. MRS is considered experimental, investigational, or unproven for all other indications listed, including breast cancer, prostate cancer, epilepsy, dementia and movement disorders, and traumatic brain injury. CPT 76390 is covered for the listed indications, and CPT codes 0609T, 0610T, 0611T and 0612T are not covered for the indications listed. The policy was last reviewed 03/26/2026.
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
Whole Gland Cryoablation of Prostate Cancer
Whole gland cryoablation of the prostate may be considered medically necessary as treatment of clinically localized (organ-confined) prostate cancer. This applies when it is performed as initial treatment or as salvage treatment of disease that recurs following radiotherapy. Subtotal (focal) cryoablation is addressed in the Focal Treatments for Prostate Cancer medical policy.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Prostate Cancer (BRCA1/2, Homologous Recombination Repair Gene Alterations, NTRK Gene Fusion)
Germline BRCA1/2 variant analysis for individuals with metastatic castrate-resistant prostate cancer (mCRPC) to select treatment with FDA-approved targeted therapies may be considered medically necessary. Somatic tissue biopsy testing for homologous recombination repair (HRR) gene alterations, and somatic circulating tumor DNA (liquid biopsy) testing for BRCA1, BRCA2, and ATM alterations, may be considered medically necessary for mCRPC to select FDA-approved targeted therapies. NTRK gene fusion testing in mCRPC to select FDA-approved targeted therapies may be considered medically necessary, a statement added in the 02/03/2025 policy update. All other uses of these tests to guide prostate cancer targeted therapy, and simultaneous liquid and tumor biopsy testing outside paired or concurrent somatic-germline testing, are considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors
Single autologous hematopoietic cell transplantation may be considered medically necessary as salvage therapy for germ cell tumors in individuals with favorable prognostic factors who have failed a previous course of conventional-dose salvage chemotherapy, and in individuals with unfavorable prognostic factors as initial treatment of first relapse or with platinum-refractory disease. Tandem autologous transplant or transplant with sequential high-dose chemotherapy may be considered medically necessary for testicular tumors as salvage therapy or with platinum-refractory disease, while autologous transplant as a component of first-line treatment and allogeneic transplant to treat germ cell tumors are considered investigational. The policy history records a review on 07/27/2026 with policy statements unchanged and ICD-9 procedure and diagnosis codes removed from the Code Reference section.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Therapeutic Radiopharmaceuticals for Prostate Cancer
Lutetium Lu 177 vipivotide tetraxetan (Lu-177-PSMA-617) may be considered medically necessary for adults with PSMA-positive metastatic castration-resistant prostate cancer who have 1 or more PSMA-positive lesions, or metastatic disease that is predominately PSMA-positive with no dominant PSMA-negative metastatic lesions, and who have been treated previously with androgen receptor-directed therapy and taxane-based chemotherapy. It is considered investigational for prostate cancer when these criteria are not met. In March 2025, the FDA indication for Lu-177-PSMA-617 was updated to also include individuals with PSMA-positive mCRPC who have been treated with AR pathway inhibition and are considered appropriate to delay taxane-based chemotherapy.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C79.82?

There are 13 tracked policy changes affecting code C79.82, including updates from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C79.82?

Payers that have issued tracked updates for code C79.82 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna, Healthfirst.

How do I get notified when code C79.82 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C79.82. 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 C79.82?

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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Lupron (leuprolide acetate)

Focal Therapies for Prostate Cancer Treatment 7.01.01

Germline Genetic Testing for Hereditary Cancers 2.02.60

Transvaginal Ultrasonography (CPB 0530, reviewed 2026-08-20)

Prostate Cancer Awareness Month (Sept 2026): Documentation and Coding Resources for Your Practice

Irreversible Electroporation (NanoKnife) (CPB 0828, reviewed 2026-03-03)

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

Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)

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

Whole Gland Cryoablation of Prostate Cancer

Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Prostate Cancer (BRCA1/2, Homologous Recombination Repair Gene Alterations, NTRK Gene Fusion)

Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors

Therapeutic Radiopharmaceuticals for Prostate Cancer

What insurance policy changes affect code C79.82?

Which payers have updated policy for code C79.82?

How do I get notified when code C79.82 policy changes?

Why do payers change policies for code C79.82?