What insurance policy changes affect code D13.5?

There are 3 tracked policy changes affecting code D13.5, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D13.5?

Payers that have issued tracked updates for code D13.5 include: Aetna.

How do I get notified when code D13.5 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D13.5. 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 D13.5?

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

D13.5 Insurance Policy Changes

ICD-10 D13.5 is officially defined as "Benign neoplasm of extrahepatic bile ducts." code D13.5 is referenced in 3 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 D13.5 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 30, 2026Medium impact
In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-26)
Aetna Clinical Policy Bulletin 0783 addresses in vivo analysis of gastrointestinal and urothelial lesions. It considers confocal laser endomicroscopy, including Cellvizio probe-based confocal laser endomicroscopy, and in-vivo analysis of colorectal polyps experimental, investigational, or unproven for the indications listed, because the effectiveness of these approaches has not been established. The source lists CPT and ICD-10 codes as not covered for the indications in the policy and gives a last review date of 10/26/2026.
Aetna · Identified Aug 19, 2026Medium impact
In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2025-12-11)
Aetna Clinical Policy Bulletin 0783 considers confocal laser endomicroscopy (including Cellvizio probe-based confocal laser endomicroscopy) experimental, investigational, or unproven for the indications it lists, because the effectiveness of these approaches has not been established. The listed indications include assessment of safe surgical margins during laryngectomy, confirmation of low-grade dysplasia and surveillance of Barrett's esophagus, diagnosis and histologic grading of bladder cancer, diagnosis and staging of lung cancer, diagnosis of prostate cancer, diagnosis of head and neck squamous cell carcinoma, differentiation of colorectal polyps during routine colonoscopy, and diagnosis of indeterminate biliary strictures and pancreatic lesions. The policy also lists elastic-scattering spectroscopy for colonic polyps, ERCP with optical endomicroscopy for biliary lesions, and in vivo analysis of colorectal polyps (including chromoendoscopy, endocytoscopy, narrow-band imaging, multi-band imaging and the Optical Biopsy System) as experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Pancreaticoduodenectomy (Whipple Resection) (CPB 0365, reviewed 2026-05-22)
Aetna considers pancreaticoduodenectomy (Whipple resection) medically necessary for ampullary adenoma or carcinoma, cholangiocarcinoma, chronic pancreatitis, combined pancreatic and duodenal injury, duodenal neoplasm, intraductal papillary mucinous neoplasm of the pancreas with high-grade dysplasia or invasive cancer, neuroendocrine tumors, and pancreatic adenocarcinoma. Aetna considers Whipple resection experimental, investigational, or unproven for Zollinger-Ellison syndrome. Immuno-nutrition, intraoperative liquid biopsy for detecting R1 resection, intraoperative pancreas stump perfusion assessment, and pre-operative biliary drainage with an omental flap for preventing complications are listed as experimental, investigational, or unproven.

Watch D13.5

Get one email when a payer policy names D13.5, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-26)

In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2025-12-11)

Pancreaticoduodenectomy (Whipple Resection) (CPB 0365, reviewed 2026-05-22)

What insurance policy changes affect code D13.5?

Which payers have updated policy for code D13.5?

How do I get notified when code D13.5 policy changes?

Why do payers change policies for code D13.5?