D06.0 Insurance Policy Changes

ICD-10 D06.0 is officially defined as "Carcinoma in situ of endocervix." code D06.0 is referenced in 8 tracked payer policy changes from Harvard Pilgrim Health Care, Regence BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D06.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Harvard Pilgrim Health Care · Effective Jan 1, 2027Medium impact
Cervical cancer screening updates
Effective for dates of service beginning January 1, 2027, Harvard Pilgrim Health Care Commercial and Tufts Health Direct products will require modifier 33 in the first modifier field, plus one listed cervical diagnosis code in the primary position, on specified biopsy, colposcopy, dual stain, and pathology codes so those services are considered preventive under the cervical cancer screening benefit. The practice should update charge entry and claim edits to capture the modifier and diagnosis sequence for these plans before that date.
Regence BlueShield · Effective Nov 1, 2026Medium impact
Surgical Site of Care- Hospital Outpatient
Effective November 1, 2026, site of care medical necessity reviews apply to the listed surgical procedures only when they are performed in an outpatient hospital setting. Use of a hospital outpatient department instead of an ambulatory surgery center or physician office may be considered medically necessary when one or more listed criteria are met, such as no geographically accessible in-network ASC that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring or treatment, ASA Physical Status III or higher, or a BMI over 40. Hospital outpatient use is considered not medically necessary when the criteria are not met.
Aetna · Identified Aug 15, 2026Medium impact
Human Papillomavirus (HPV) Vaccine (CPB 0726, reviewed 2025-11-25)
Aetna considers Gardasil 9 (9-valent HPV vaccine) medically necessary as a preventive service for persons age 9 to 45 years. Aetna considers Gardasil 9 not medically necessary for persons who have completed a three-dose series with Gardasil or Cervarix, but it is medically necessary to continue or complete the three-dose series when the previously administered HPV vaccine product is not known or not available. Aetna considers Gardasil 9 experimental, investigational, or unproven for indications including treatment of active genital warts, cervical cancer, anal squamous cell carcinoma, vulvar and vaginal cancer, and prevention of recurrence of anogenital warts.
Aetna · Identified Aug 14, 2026Medium impact
Endometrial Cancer Screening, Diagnosis, and Prognosis (CPB 0769, reviewed 2025-10-03)
Aetna considers endometrial biopsy medically necessary for the diagnostic evaluation of abnormal uterine bleeding in women suspected of having endometrial hyperplasia or endometrial carcinoma, and for endometrial cancer surveillance in women with Lynch syndrome. The endometrial brush (Tao brush) is an acceptable alternative to a suction curette such as the Pipelle for medically necessary sampling. Sentinel lymph node mapping is medically necessary for pathologic evaluation and surgical staging in persons with endometrial cancer and endometrial intraepithelial neoplasia (EIN), while endometrial biopsy for screening and many biomarker and genetic tests for endometrial cancer are experimental, investigational, or unproven.
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 13, 2026Medium impact
Plerixafor (CPB 0779, reviewed 2026-02-13)
Aetna's policy covers plerixafor (Mozobil or generic plerixafor) for hematopoietic stem cell mobilization when it is given after a granulocyte-colony stimulating factor such as filgrastim, after chemo-mobilization, or as part of a gene therapy protocol, and when it is not used beyond 4 consecutive days or after stem cell harvest or apheresis is complete. Continuation of therapy is considered medically necessary for members who meet the initial selection criteria. Aetna considers plerixafor experimental, investigational or unproven for all other indications, including the conditions listed in the policy such as acute leukemias, sickle cell disease, WHIM syndrome and neutropenia treatment.
Aetna · Identified Aug 13, 2026Medium impact
Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)
Aetna considers albumin-bound paclitaxel (Abraxane or generic albumin-bound paclitaxel) medically necessary for the cancers listed in its initial approval criteria, including Kaposi sarcoma, breast cancer, cutaneous melanoma, endometrial carcinoma, ovarian, fallopian tube and primary peritoneal cancer, biliary tract cancers, non-small cell lung cancer, pancreatic adenocarcinoma, small bowel adenocarcinoma, uveal melanoma, ampullary adenocarcinoma, cervical cancer, bladder cancer and vaginal cancer, when each cancer's stated criteria are met. All other indications are considered experimental, investigational, or unproven, including small cell lung cancer, prostate cancer, soft-tissue sarcoma and gastric cancer. Continuation of therapy is medically necessary for an approved indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
Aetna · Identified Aug 12, 2026Medium impact
Atezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (CPB 0909, reviewed 2026-06-30)
Aetna's commercial coverage policy for atezolizumab (Tecentriq) and atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza) covers them for specific indications when the criteria are met. Covered indications include recurrent, advanced or metastatic non-small cell lung cancer, extensive-stage small cell lung cancer, hepatocellular carcinoma in combination with bevacizumab, BRAF V600 mutation-positive melanoma in combination with cobimetinib and vemurafenib, alveolar soft part sarcoma, and adjuvant treatment of muscle invasive bladder cancer after cystectomy when the member is positive for circulating tumor DNA molecular residual disease. Precertification is required in applicable plan designs, and the Site of Care Utilization Management Policy applies. Use for all other indications is considered experimental, investigational, or unproven, and members are not eligible after disease progression on PD-1 or PD-L1 inhibitor therapy.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D06.0?

There are 8 tracked policy changes affecting code D06.0, including updates from Harvard Pilgrim Health Care, Regence BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D06.0?

Payers that have issued tracked updates for code D06.0 include: Harvard Pilgrim Health Care, Regence BlueShield, Aetna.

How do I get notified when code D06.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D06.0. 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 D06.0?

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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Cervical cancer screening updates

Surgical Site of Care- Hospital Outpatient

Human Papillomavirus (HPV) Vaccine (CPB 0726, reviewed 2025-11-25)

Endometrial Cancer Screening, Diagnosis, and Prognosis (CPB 0769, reviewed 2025-10-03)

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

Plerixafor (CPB 0779, reviewed 2026-02-13)

Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)

Atezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (CPB 0909, reviewed 2026-06-30)

What insurance policy changes affect code D06.0?

Which payers have updated policy for code D06.0?

How do I get notified when code D06.0 policy changes?

Why do payers change policies for code D06.0?