D01.0 Insurance Policy Changes

ICD-10 D01.0 is officially defined as "Carcinoma in situ of colon." code D01.0 is referenced in 3 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D01.0 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 · Effective Oct 1, 2026Medium impact
Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
Already effective 10/01/2026: ICD-10 diagnosis code QA1.71 was added for Lynch syndrome. Genetic testing of the APC gene may be considered medically necessary for at-risk relatives of individuals with familial adenomatous polyposis or a known APC variant, and for individuals with a differential diagnosis of attenuated FAP, MUTYH-associated polyposis, or Lynch syndrome. Genetic testing of MMR genes (MLH1, MSH2, MSH6, PMS2) may be considered medically necessary for individuals with colorectal or endometrial cancer whose tumor testing suggests germline MMR deficiency or who meet clinical criteria for Lynch syndrome, and for individuals without cancer who meet the Amsterdam or Revised Bethesda criteria or have a 5% or higher predicted risk on a validated risk prediction model when no affected family members have been tested. Testing for germline APC, MUTYH, MMR, EPCAM, SMAD4, BMPR1A, and STK11 variants for inherited colorectal cancer syndromes is considered investigational in all other situations.
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 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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D01.0?

There are 3 tracked policy changes affecting code D01.0, 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 D01.0?

Payers that have issued tracked updates for code D01.0 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna.

How do I get notified when code D01.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D01.0. 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 D01.0?

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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Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes

Germline Genetic Testing for Hereditary Cancers 2.02.60

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

What insurance policy changes affect code D01.0?

Which payers have updated policy for code D01.0?

How do I get notified when code D01.0 policy changes?

Why do payers change policies for code D01.0?