D59.11 Insurance Policy Changes

ICD-10 D59.11 is officially defined as "Warm autoimmune hemolytic anemia." code D59.11 is referenced in 12 tracked payer policy changes from UnitedHealthcare and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D59.11 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UnitedHealthcare Community Plan of Tennessee revised its FcRn Blockers medical benefit drug policy, with a stated effective date of 2027-01-01. Imaavy (nipocalimab-aahu) is now covered as proven and medically necessary for warm autoimmune hemolytic anemia (wAIHA) in adults and children 12 and older who are currently or were previously treated with corticosteroids, subject to documentation, prescriber, dosing and combination-therapy criteria; ICD-10 code D59.11 was added to the policy's applicable codes.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
Medicaid members in Pennsylvania under the UnitedHealthcare Community Plan will see revised FcRn blocker coverage criteria effective 2027-01-01. Imaavy (nipocalimab-aahu) is now described as proven and medically necessary for warm autoimmune hemolytic anemia (wAIHA) in patients 12 years and older who are currently or were previously treated with corticosteroids, subject to documented diagnosis, prior therapy and prescriber requirements. ICD-10 code D59.11 was added to the applicable codes.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
Effective 2027-01-01, UnitedHealthcare Community Plan of New Mexico (Medicaid) revised its FcRn Blockers medical benefit drug policy to state that Imaavy (nipocalimab-aahu) is proven and medically necessary for warm autoimmune hemolytic anemia (wAIHA) in adults and children 12 and older who currently or previously received corticosteroids, with added ICD-10 code D59.11. Billing teams should align prior authorization requests, documentation and charge entry for Imaavy and the other listed FcRn blocker products (Rystiggo, Vyvgart, Vyvgart Hytrulo IV/SC vial) with the revised criteria.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UnitedHealthcare Community Plan of New Jersey revised its FcRn Blockers medical benefit drug policy, expanding coverage for Imaavy (nipocalimab-aahu) in warm autoimmune hemolytic anemia (wAIHA) in adults and pediatric patients 12 and older who are currently or previously treated with corticosteroids. Billing teams should expect new medical-record documentation requirements (confirmed diagnosis, DAT results, prescriber involvement, and prior treatment history), a 12-month initial authorization limit, and the addition of ICD-10 code D59.11 to applicable diagnosis codes.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UnitedHealthcare Community Plan of Kentucky revised its FcRn Blockers medical benefit drug policy, effective 2027-01-01, to state that Imaavy is proven and medically necessary for warm autoimmune hemolytic anemia (wAIHA) in adults and children 12 and older currently or previously treated with corticosteroids, subject to specified diagnostic, treatment-history, dosing and prescriber criteria. ICD-10 code D59.11 was added to the applicable codes, and the policy covers Imaavy, Rystiggo, Vyvgart and Vyvgart Hytrulo vial for administration by a healthcare professional.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UnitedHealthcare Community Plan of Indiana revised its FcRn Blockers medical benefit drug policy, effective 2027-01-01, to add coverage language for Imaavy (nipocalimab-aahu) in treating warm autoimmune hemolytic anemia (wAIHA) in adults and pediatric patients 12 years and older who have been treated with corticosteroids. Coverage requires documented diagnosis, prior corticosteroid, immunosuppressant or rituximab history, hematologist involvement, and no concurrent rituximab or immune globulin; ICD-10 code D59.11 was added.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UnitedHealthcare Community Plan revised its FcRn Blocker medical benefit drug policy, adding Imaavy (nipocalimab-aahu) coverage for warm autoimmune hemolytic anemia (wAIHA) in adult and pediatric patients 12 years and older who have been treated with corticosteroids, and adding ICD-10 code D59.11. Claims for Imaavy under this indication will need initial or continuation criteria documented, including a DAT-positive or qualifying negative-DAT workup, prior corticosteroid or immunosuppressant treatment, rituximab trial or failure, hematologist involvement, and FDA-labeled dosing.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UnitedHealthcare revised its FcRn Blockers medical benefit drug policy, effective 2027-01-01, for Individual Exchange plans. Imaavy (nipocalimab-aahu) is now covered for warm autoimmune hemolytic anemia (wAIHA) in adults and patients 12 and older who were currently or previously treated with corticosteroids, subject to the listed criteria including a confirmed wAIHA diagnosis, hematologist involvement, and FDA-labeled dosing; ICD-10 code D59.11 was added. The policy also moved to a shared template that applies to both UnitedHealthcare Commercial and Individual Exchange plans.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UMR's revised FcRn Blockers medical benefit drug policy, effective 2027-01-01, moves the policy to a shared template that applies to UnitedHealthcare Commercial and Individual Exchange benefit plans and adds clinical criteria for Imaavy (nipocalimab-aahu) in warm autoimmune hemolytic anemia (wAIHA) for adults and pediatric patients 12 years and older treated with corticosteroids. Billing teams should prepare documentation and prior authorization workflows for Imaavy wAIHA requests, and add ICD-10 D59.11 to charge entry and claim review where applicable.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
Surest's FcRn Blockers medical benefit drug policy was revised, effective 2027-01-01, to move onto a shared template covering UnitedHealthcare Commercial and Individual Exchange plans. The revision adds medical necessity criteria for Imaavy (nipocalimab-aahu) in warm autoimmune hemolytic anemia (wAIHA) in adults and pediatric patients 12 years and older previously or currently treated with corticosteroids, and adds ICD-10 code D59.11. The practice should prepare documentation for initial and continuation requests before scheduling Imaavy for these members.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
FcRn Blockers
UnitedHealthcare revised its FcRn Blockers medical benefit drug policy, effective 2027-01-01, moving it to a shared template that applies to both UnitedHealthcare Commercial and Individual Exchange plans. The revision adds coverage criteria for Imaavy (nipocalimab-aahu) in warm autoimmune hemolytic anemia (wAIHA) for adults and pediatric patients 12 years and older, with initial and continuation criteria covering diagnosis documentation, prior corticosteroid or immunosuppressant treatment, rituximab trial/failure or intolerance, no concurrent rituximab or immune globulin for the same indication, FDA-labeled dosing, hematologist prescribing, and authorization periods of up to 12 months. ICD-10 code D59.11 was added.
Blue Cross & Blue Shield of Mississippi · Effective Jan 1, 2026Medium impact
Telehealth: Remote Patient Monitoring Services
BCBSMS policy L.2.04.439 covers remote patient monitoring services, which must be prior authorized and ordered by a Physician, and must be performed by a Mississippi-licensed Provider affiliated with a Mississippi health care facility. An initial monitoring episode is allowed for up to 31 days, further monitoring requires an updated plan of care and re-authorization, and coverage is not provided beyond a six-month period. The 01/01/2026 update added CPT 98984, 98985, 98986 and 99445 and revised the descriptions of CPT 98976, 98977, 98980, 98981, 99453, 99454, 99457 and 99458.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D59.11?

There are 12 tracked policy changes affecting code D59.11, including updates from UnitedHealthcare, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D59.11?

Payers that have issued tracked updates for code D59.11 include: UnitedHealthcare, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code D59.11 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D59.11. 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 D59.11?

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.

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FcRn Blockers

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Telehealth: Remote Patient Monitoring Services

What insurance policy changes affect code D59.11?

Which payers have updated policy for code D59.11?

How do I get notified when code D59.11 policy changes?

Why do payers change policies for code D59.11?