D18.09 Insurance Policy Changes

ICD-10 D18.09 is officially defined as "Hemangioma of other sites." code D18.09 is referenced in 17 tracked payer policy changes from Excellus BlueCross BlueShield, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D18.09 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Oct 15, 2026Medium impact
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty - (Effective Date - 2026-10-15) 6.01.17
Vertebral augmentation with PMMA cement under imaging guidance is medically necessary for prophylactic vertebroplasty to facilitate fusion surgery, and for malignant conditions including osteolytic metastases, destruction of a vertebral body by multiple myeloma, or primary malignant neoplasm of bone or bone marrow with daily clinically significant pain. For non-malignant conditions it is medically necessary for osteoporotic or osteolytic vertebral compression fractures, aggressive space-occupying lesions (hemangioma or eosinophilic granuloma), osteonecrotic (Kummel disease) fractures, and steroid-induced fractures when imaging matches symptoms and exam findings and the pain duration and treatment criteria are met. Vertebral augmentation is not medically necessary with listed contraindications such as allergy to materials, uncorrected coagulation disorder or anticoagulation therapy, active infection, or active osteomyelitis of the target vertebra, and percutaneous sacroplasty is investigational for all indications.
Independence Blue Cross · Effective Apr 1, 2026Medium impact
MA11.071b, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
Independence Blue Cross reissued MA11.071b on 04/01/2026 to reaffirm its coverage position on selective photothermolysis using pulsed-dye lasers (PDL). The policy clarifies that PDL treatment for psoriasis, molluscum contagiosum, basal cell carcinoma, cutaneous lupus erythematosus, and cutaneous sarcoidosis remains experimental/investigational and non-covered. The policy also updated criteria for rosacea treatment to align with current clinical standards and added specific ICD-10 diagnosis codes for non-covered indications.
Independence Blue Cross · Effective Apr 1, 2026Medium impact
11.08.04i, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
Independence Blue Cross reissued Policy 11.08.04i on 04/01/2026 reaffirming its continuing position on PDL treatment coverage. The policy clarifies medically necessary indications (port wine stains, hemangiomas, hypertrophic/keloidal scars, pyogenic granulomas, viral warts, and rosacea), designates specific conditions as experimental/investigational (psoriasis, molluscum contagiosum, basal cell carcinoma, cutaneous lupus), and updates rosacea treatment criteria to require 6-month failed medical management before PDL coverage. Billing teams must verify patient diagnoses against the expanded ICD-10 code list and confirm medical necessity documentation for rosacea cases.
Independence Blue Cross · Effective Feb 2, 2026Medium impact
MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)
Independence Blue Cross reissued MA07.003f on 02/02/2026 with no substantive changes to photodynamic therapy coverage criteria, but removed 15 ICD-10 diagnosis codes that are no longer covered under this policy. The policy aligns with CMS National Coverage Determinations (NCDs) for verteporfin PDT treatment of choroidal neovascularization associated with AMD, presumed ocular histoplasmosis, and pathologic myopia. Billing teams must remove the deleted ICD-10 codes from claim submission logic to prevent denials.
Independence Blue Cross · Effective Nov 17, 2025Medium impact
07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Independence Blue Cross reissued Policy 07.13.05m on its existing terms with no substantive changes to PDT verteporfin coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claim submissions for certain macular degeneration and choroidal conditions. Billing teams must verify that claims use only the diagnosis codes now listed in the policy to avoid denials.
Independence Blue Cross · Effective Nov 17, 2025Medium impact
07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Independence Blue Cross reissued policy 07.13.05m on photodynamic therapy (PDT) using verteporfin with no substantive changes to coverage criteria. However, 12 ICD-10 diagnosis codes were removed effective 11/17/2025, which may affect claims processing for certain ocular conditions. Billing teams must verify that claims for PDT use only the ICD-10 codes listed in the current policy to avoid denials.
Aetna · Identified Oct 13, 2026Medium impact
Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-10-05)
Aetna considers transpupillary thermotherapy medically necessary for retinoblastoma involving less than 50% of the retina and without associated vitreal or sub-retinal seeds at the time of thermotherapy, and for small (2 to 3 mm) choroidal melanomas located posterior in the globe. Aetna considers transpupillary thermotherapy experimental, investigational, or unproven for all other indications, including central serous chorioretinopathy, choroidal neovascularization associated with age-related macular degeneration, circumscribed choroidal hemangioma, retinopathy of prematurity and polypoidal choroidal vasculopathy. The stated reason is the lack of prospective, controlled clinical studies supporting its effectiveness for these indications.
Aetna · Identified Aug 19, 2026Medium impact
Verteporfin (Visudyne) Photodynamic Therapy (CPB 0594, reviewed 2026-04-24)
Aetna's policy for commercial medical plans covers verteporfin (Visudyne) photodynamic therapy under CPT 67221 and 67225 when the criteria are met. Covered indications are predominantly classic subfoveal choroidal neovascularization from wet age-related macular degeneration, pathologic myopia, presumed ocular histoplasmosis, or chronic central serous chorioretinopathy with a treatment spot size of 6.4 mm or less in diameter, and choroidal hemangioma. Visudyne must be prescribed by or in consultation with an ophthalmologist, and continuation therapy is covered for members with a positive clinical response; combination with anti-angiogenic agents for AMD and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)
Aetna considers transpupillary thermotherapy medically necessary for retinoblastoma involving less than 50% of the retina, without associated vitreal or sub-retinal seeds at the time of thermotherapy, and for small (2 to 3 mm) choroidal melanomas located posterior in the globe. Aetna considers transpupillary thermotherapy experimental, investigational, or unproven for all other indications, including central serous chorioretinopathy, choroidal metastases, choroidal neovascularization associated with age-related macular degeneration, polypoidal choroidal vasculopathy, and retinopathy of prematurity.
Aetna · Identified Aug 17, 2026Medium impact
Stereotactic Radiosurgery (CPB 0083, reviewed 2026-03-11)
Aetna considers stereotactic radiosurgery (SRS) medically necessary in certain circumstances, and refers to the eviCore Healthcare Radiation Therapy Clinical Guidelines for medical necessity criteria. Cranial SRS is medically necessary for benign brain and spinal tumors, cranial arteriovenous malformations, cavernous malformations and hemangiomas, trigeminal neuralgia that has not responded to more conservative treatments, severe essential tremor not adequately responsive to standard medical therapy, disabling tremor in Parkinson's disease for patients who meet thalamotomy criteria but are not surgical candidates, and primary brain tumors and primary or secondary tumors involving the spine. For brain metastases, SRS is considered appropriate with a Karnofsky Performance Status of 40 or greater (or expected to return to 70 or greater), or an ECOG status of 3 or less (or expected to return to 2 or less), fewer than 10 metastatic lesions, and control of or expected control of extracranial disease. Stereotactic body radiation therapy is medically necessary for liver or hepatobiliary cancer stage I to II, organ-confined prostate cancer, inoperable stage I or IIA lung cancer, unresectable stage I to III pancreatic cancer, recurrent disease requiring re-irradiation, and oligometastatic breast, non-small cell lung, colorectal, renal cell, prostate, sarcoma, melanoma and head and neck cancers with 1 to 5 total metastases, and Aetna considers SRS experimental, investigational, or unproven for cluster headaches, epilepsy (except when associated with treatment of arteriovenous malformations or brain tumors), and mammographic microcalcification.
Aetna · Identified Aug 16, 2026Medium impact
Lymphangioma and Infantile Hemangioma (CPB 0817, reviewed 2025-12-03)
Treatment of hemangiomas of infancy is medically necessary when the lesion compromises vital structures such as the nose, eyes, ears, lips or larynx, is associated with Kasabach-Merritt Syndrome, is symptomatic, or results in a documented functional impairment, using cryosurgery or cryotherapy, embolization, intralesional steroids, laser therapy, radiotherapy, sclerosing therapy or surgical excision alone or in combination. Oral propranolol for proliferating infantile hemangioma requiring systemic therapy (corticosteroids) is medically necessary, and inpatient initiation is medically necessary for infants 8 weeks or younger (corrected age), infants without adequate social support, and infants with co-morbid cardiovascular, airway or blood glucose conditions. Atenolol, pigment epithelium-derived factor, topical timolol, C19MC microRNA and serum VEGF biomarker measurements, and sirolimus for diffuse intestinal infantile hemangioma are considered experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)
Aetna's Clinical Policy Bulletin 0815 covers ipilimumab (Yervoy) for commercial medical plans. It considers ipilimumab medically necessary for the cancer indications listed in the policy, many of them in combination with nivolumab, and considers continued treatment medically necessary for members requesting reauthorization when there is no evidence of unacceptable toxicity or disease progression. It considers ipilimumab experimental, investigational, or unproven for indications such as glioblastoma, pancreatic cancer, and prostate cancer, and for use with bevacizumab, vemurafenib, dabrafenib, or trametinib.
Aetna · Identified Aug 14, 2026Medium impact
Electroretinography (CPB 0854, reviewed 2025-12-24)
The electroretinography (ERG) policy was last reviewed December 24, 2025. ERG is medically necessary for the work-up of congenital nystagmus and as an adjunctive modality for establishing loss of retinal function and distinguishing retinal from optic nerve lesions, full-field ERG is medically necessary for congenital stationary night blindness and for evaluating Vogt-Koyanagi-Harada disease and exudative retinal detachment, and multi-focal ERG is medically necessary for detecting chloroquine and hydroxychloroquine toxicity. ffERG or mfERG is medically necessary for evaluating Stargardt disease in children, while full-field flash ERG monitoring during endoscopic trans-sphenoidal pituitary mass resection, global flash ERG for refractive errors, and pattern ERG for antidepressant selection, amblyopia, depression, glaucoma, macular drusen and all other indications are experimental, investigational or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Prolotherapy and Sclerotherapy (CPB 0207, reviewed 2026-03-27)
Aetna's Clinical Policy Bulletin 0207, last reviewed 03/27/2026, considers sclerotherapy medically necessary for a list of conditions, including active esophageal variceal hemorrhage in persons who failed to adequately respond to or cannot undergo endovenous ligation, symptomatic hemorrhoids when conservative treatments have failed, venous ulcerations, symptomatic venous malformations, and symptomatic renal cysts that are 3 to 20 cm in size. Ultrasound-guided percutaneous cyst aspiration with sclerotherapy is considered medically necessary for symptomatic, large (4 cm or larger), simple hepatic cysts. Prolotherapy is considered experimental, investigational or unproven for all indications, and so are neural prolotherapy, Prolozone therapy for any diagnosis, Sarapin for all indications, and electro-sclerotherapy for capillary malformations.
Aetna · Identified Aug 13, 2026Medium impact
Eribulin Mesylate (Halaven) (CPB 0831, reviewed 2026-06-19)
Aetna covers eribulin mesylate (Halaven) as single-agent therapy for recurrent unresectable or metastatic breast cancer when the disease is HER2-negative, or in combination with margetuximab-cmkb or trastuzumab for HER2-positive disease as fourth line therapy and beyond. Single-agent use is also covered for dedifferentiated liposarcoma with or without concurrent well-differentiated liposarcoma, epithelioid hemangioendothelioma, extremity/body wall or head/neck, pleomorphic rhabdomyosarcoma, and retroperitoneal/intra-abdominal soft tissue sarcoma. Continuation of therapy is covered when there is no evidence of unacceptable toxicity or disease progression on the current regimen, and all other indications are considered experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Photodynamic Therapy for Choroidal Neovascularization
BCBSMS considers verteporfin photodynamic therapy as monotherapy medically necessary for choroidal neovascularization associated with age-related macular degeneration, pathologic myopia, presumed ocular histoplasmosis, chronic central serous chorioretinopathy, or choroidal hemangioma. Verteporfin photodynamic therapy as monotherapy for other ophthalmologic disorders is considered investigational. Verteporfin photodynamic therapy combined with ranibizumab, bevacizumab, aflibercept, brolucizumab-dbll or faricimab-svoa is also considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Ophthalmologic Techniques That Evaluate the Posterior Eye Segment for Glaucoma
Analysis of the optic nerve and retinal nerve fiber layer in individuals with glaucoma or glaucoma suspects may be considered medically necessary when using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. Measurement of ocular blood flow, pulsatile ocular blood flow, or blood flow velocity is considered investigational in the diagnosis and follow-up of individuals with glaucoma. The most recent update dated 08/25/2026 updated the policy description regarding devices and removed ICD-9 procedure and diagnosis codes, with policy statements unchanged.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D18.09?

There are 17 tracked policy changes affecting code D18.09, including updates from Excellus BlueCross BlueShield, Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D18.09?

Payers that have issued tracked updates for code D18.09 include: Excellus BlueCross BlueShield, Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code D18.09 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D18.09. 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 D18.09?

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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Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty - (Effective Date - 2026-10-15) 6.01.17

MA11.071b, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)

11.08.04i, Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)

MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)

07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)

07.13.05m, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)

Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-10-05)

Verteporfin (Visudyne) Photodynamic Therapy (CPB 0594, reviewed 2026-04-24)

Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)

Stereotactic Radiosurgery (CPB 0083, reviewed 2026-03-11)

Lymphangioma and Infantile Hemangioma (CPB 0817, reviewed 2025-12-03)

Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)

Electroretinography (CPB 0854, reviewed 2025-12-24)

Prolotherapy and Sclerotherapy (CPB 0207, reviewed 2026-03-27)

Eribulin Mesylate (Halaven) (CPB 0831, reviewed 2026-06-19)

Photodynamic Therapy for Choroidal Neovascularization

Ophthalmologic Techniques That Evaluate the Posterior Eye Segment for Glaucoma

What insurance policy changes affect code D18.09?

Which payers have updated policy for code D18.09?

How do I get notified when code D18.09 policy changes?

Why do payers change policies for code D18.09?