D01.1 Insurance Policy Changes

ICD-10 D01.1 is officially defined as "Carcinoma in situ of rectosigmoid junction." code D01.1 is referenced in 5 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D01.1 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.
Aetna · Identified Oct 29, 2026Medium impact
Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0747, last reviewed 10/21/2026, covers transanal endoscopic microsurgery (TEM). Aetna considers TEM medically necessary for benign rectal tumors (adenomas), low-risk Tis and T1 rectal carcinoma, and small rectal carcinoids less than 2 cm in diameter. Aetna considers TEM experimental, investigational, or unproven for other indications, including advanced rectal cancer, anorectal melanoma, benign rectal strictures, rectal prolapse and diverticula, and megacolon. The source text does not describe what changed in this review.
Aetna · Identified Aug 18, 2026Medium impact
Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2025-11-26)
Aetna covers transanal endoscopic microsurgery (TEM) for benign rectal tumors (adenomas), low-risk Tis and T1 rectal carcinoma, and small rectal carcinoids less than 2 cm in diameter. Aetna considers TEM experimental, investigational, or unproven for other indications, including advanced rectal cancer, anorectal melanoma, benign rectal strictures, rectal prolapse and diverticula, rectal schwannoma, and recto-urinary and recto-vesical fistulas. The covered CPT code is 0184T, and the policy lists the ICD-10 codes that are covered if selection criteria are met and the codes not covered for the listed indications.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Low impact
Transanal Endoscopic Microsurgery
Transanal endoscopic microsurgery may be considered medically necessary for treatment of rectal adenomas, including recurrent adenomas, that cannot be removed using other means of local excision. It may also be considered medically necessary for clinical stage T1 rectal adenocarcinomas that cannot be removed using other means of local excision and that meet all listed criteria. Transanal endoscopic microsurgery is investigational for rectal tumors that do not meet those criteria. The 05/19/2026 review left the policy statements unchanged and removed ICD-9 procedure and diagnosis codes from the code reference.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D01.1?

There are 5 tracked policy changes affecting code D01.1, including updates from Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D01.1?

Payers that have issued tracked updates for code D01.1 include: Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code D01.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D01.1. 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 D01.1?

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

Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2026-10-21)

Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2025-11-26)

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

Transanal Endoscopic Microsurgery

What insurance policy changes affect code D01.1?

Which payers have updated policy for code D01.1?

How do I get notified when code D01.1 policy changes?

Why do payers change policies for code D01.1?