D25.1 Insurance Policy Changes

ICD-10 D25.1 is officially defined as "Intramural leiomyoma of uterus." code D25.1 is referenced in 5 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, 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 D25.1 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 · Identified Jun 20, 2026High impact
Lupron (leuprolide acetate)
Prior authorization is required for Lupron (leuprolide). The 08/01/2026 revision adds medically necessary coverage for Eligard (leuprolide acetate) and leuprolide acetate depot for advanced prostate cancer, and it lists Camcevi (leuprolide), Lutrate Depot (leuprolide acetate kit), Vabrinty (leuprolide acetate) and Fensolvi (leuprolide acetate) as not covered on any BCBSMS Formulary. Lupron may be considered medically necessary for endometriosis, uterine leiomyomata, central precocious puberty, or prostate cancer when the initial criteria for that indication are documented.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Occlusion of Uterine Arteries Using Transcatheter Embolization
Transcatheter embolization of uterine arteries is considered medically necessary as a treatment of uterine fibroids or as a treatment of postpartum uterine hemorrhage. One repeat transcatheter embolization of uterine arteries to treat persistent fibroid symptoms after an initial uterine artery embolization may be considered medically necessary. Transcatheter embolization for cervical ectopic pregnancy, uterine arteriovenous malformation and adenomyosis is considered investigational.
Independence Blue Cross · Identified Jun 25, 2026Low impact
11.06.04k, Uterine Artery Embolization
Independence Blue Cross has reissued Policy 11.06.04k with no substantive changes to coverage criteria for uterine artery embolization (UAE). The policy maintains its existing position: UAE is covered for symptomatic uterine fibroids and postpartum hemorrhage, with specific medical necessity criteria. No workflow changes are required for billing operations.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.06.04k, Uterine Artery Embolization
Independence Blue Cross has reissued Policy 11.06.04k on Uterine Artery Embolization (UAE) with no substantive changes to coverage criteria, medically necessary indications, contraindications, or experimental/investigational designations. The policy continues to cover UAE for symptomatic uterine fibroids and postpartum hemorrhage under specified clinical criteria, with no new billing code, documentation, or prior authorization requirements.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D25.1?

There are 5 tracked policy changes affecting code D25.1, including updates from Blue Cross & Blue Shield of Mississippi, Regence BlueShield, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D25.1?

Payers that have issued tracked updates for code D25.1 include: Blue Cross & Blue Shield of Mississippi, Regence BlueShield, Independence Blue Cross.

How do I get notified when code D25.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D25.1. 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 D25.1?

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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Lupron (leuprolide acetate)

Surgical Site of Care- Hospital Outpatient

Occlusion of Uterine Arteries Using Transcatheter Embolization

11.06.04k, Uterine Artery Embolization

11.06.04k, Uterine Artery Embolization

What insurance policy changes affect code D25.1?

Which payers have updated policy for code D25.1?

How do I get notified when code D25.1 policy changes?

Why do payers change policies for code D25.1?