C79.9 Insurance Policy Changes

ICD-10 C79.9 is officially defined as "Secondary malignant neoplasm of unspecified site." code C79.9 is referenced in 4 tracked payer policy changes from Excellus BlueCross BlueShield, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C79.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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.
Independence Blue Cross · Effective Jun 16, 2025Medium impact
MA08.018j, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Independence Blue Cross Medicare Advantage policy MA08.018m (effective 06/16/2025) expands trastuzumab coverage criteria to include nine new cancer indications beyond breast cancer, adds one new biosimilar HCPCS code (Q5146 for Hercessi), and removes three outdated ICD-10 diagnosis codes. Billing teams must update systems to recognize new covered indications and ensure claims use current coding before the effective date.
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.
Medical Mutual of Ohio · Identified Jun 20, 2026Medium impact
HEDIS Advanced Illness and Frailty Exclusion
Medical Mutual of Ohio has implemented HEDIS exclusion guidelines for advanced illness and frailty patients. Billing teams must use specific ICD-10 codes to exclude eligible patients (ages 66-80 with both conditions, or 81+ with frailty) from certain HEDIS quality measures like cancer screenings and diabetes management.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C79.9?

There are 4 tracked policy changes affecting code C79.9, including updates from Excellus BlueCross BlueShield, Independence Blue Cross, 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 C79.9?

Payers that have issued tracked updates for code C79.9 include: Excellus BlueCross BlueShield, Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, Medical Mutual of Ohio.

How do I get notified when code C79.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C79.9. 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 C79.9?

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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Germline Genetic Testing for Hereditary Cancers 2.02.60

MA08.018j, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)

Hematopoietic Cell Transplantation for Solid Tumors of Childhood

HEDIS Advanced Illness and Frailty Exclusion

What insurance policy changes affect code C79.9?

Which payers have updated policy for code C79.9?

How do I get notified when code C79.9 policy changes?

Why do payers change policies for code C79.9?