What insurance policy changes affect code D04.0?

There are 5 tracked policy changes affecting code D04.0, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D04.0?

Payers that have issued tracked updates for code D04.0 include: Aetna.

How do I get notified when code D04.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D04.0. 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 D04.0?

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.

PAYER POLICY CHANGES

D04.0 Insurance Policy Changes

ICD-10 D04.0 is officially defined as "Carcinoma in situ of skin of lip." code D04.0 is referenced in 5 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D04.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 17, 2026Medium impact
Mohs Micrographic Surgery (CPB 0383, reviewed 2026-05-28)
Aetna's Clinical Policy Bulletin 0383 considers Mohs micrographic surgery medically necessary for lesions in areas of important tissue preservation (ears, face, feet, hands, genitalia and perianal area), atypical fibroxanthoma, dermatofibrosarcoma protuberans, lesions 2 cm or larger or rapidly growing, lesions in high-recurrence areas, previously irradiated skin, recurrent or incompletely excised malignant lesions, squamous cell carcinomas with high risk of metastasis, superficial melanoma in situ and lentigo maligna in areas of important tissue preservation, tumors with aggressive histologic patterns, and tumors with ill-defined borders. Aetna considers Mohs surgery for all other indications experimental, investigational or unproven, including adenoid cystic carcinoma, nail unit melanoma, pilomatrix carcinoma, vulvar malignancies and deep cutaneous fungal infections. Mohs micrographic surgery requires a single physician to act as both surgeon and pathologist, and the Mohs CPT codes are inappropriate if either role is delegated to another physician who reports those services separately.
Aetna · Identified Aug 14, 2026Medium impact
Ultrasound Guidance – Selected Indications (CPB 0952, reviewed 2026-04-27)
Aetna Clinical Policy Bulletin 0952 sets coverage rules for ultrasound guidance on selected procedures. CPT 76942 (ultrasonic guidance for needle placement) and 76998 (ultrasonic guidance, intraoperative) are covered when selection criteria are met, and CPT 76937 covers ultrasound guidance for vascular access. The policy lists many nerve blocks, joint, bursa, tendon, aspiration and biopsy procedures as medically necessary with ultrasound guidance, several of them only after an unguided procedure has failed, and it lists procedures for which ultrasound guidance is of no proven benefit and codes that are not covered for specific indications.
Aetna · Identified Aug 14, 2026Medium impact
Dermabrasion, Chemical Peels, and Acne Surgery (CPB 0251, reviewed 2026-04-15)
Aetna considers dermabrasion for superficial basal cell carcinomas and pre-cancerous actinic keratoses, medium and deep chemical peels for actinic keratoses when there are 15 or more lesions, and specified acne surgery procedures medically necessary when criteria are met. Dermabrasion for active acne, diffuse silicone granuloma, dyschromias, keloids, melasma and vitiligo, chemical peels for active acne, and fractional radiofrequency and micro-needling for acne scars and other listed indications are considered experimental, investigational, or unproven. Dermabrasion for scar revision and removal of acne scars, and chemical peels for acne scarring, melasma, and skin wrinkling or lentigines, are considered cosmetic.
Aetna · Identified Aug 13, 2026Medium impact
Photodynamic Therapy (CPB 0375, reviewed 2026-05-21)
Aetna considers photodynamic therapy with porfimer sodium (Photofrin) medically necessary for esophageal cancer, endobronchial non-small cell lung cancer and inoperable cholangiocarcinoma (as an adjunct to stenting) when the listed criteria are met, and experimental, investigational or unproven when they are not. Photodynamic therapy with topical photosensitizers such as methyl aminolevulinate, topical 5-fluorouracil and aminolevulinic acid is medically necessary for basal cell carcinoma, cutaneous lesions of Bowen's disease, refractory actinic keratoses, low-risk squamous cell carcinoma in situ where surgery or radiation is contraindicated or impractical, and erythroplasia of Queyrat. Photodynamic therapy is considered experimental, investigational or unproven for other cancers and for a long list of non-cancer indications, and the policy applies to commercial medical plans.
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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Mohs Micrographic Surgery (CPB 0383, reviewed 2026-05-28)

Ultrasound Guidance – Selected Indications (CPB 0952, reviewed 2026-04-27)

Dermabrasion, Chemical Peels, and Acne Surgery (CPB 0251, reviewed 2026-04-15)

Photodynamic Therapy (CPB 0375, reviewed 2026-05-21)

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

What insurance policy changes affect code D04.0?

Which payers have updated policy for code D04.0?

How do I get notified when code D04.0 policy changes?

Why do payers change policies for code D04.0?