D59.19 Insurance Policy Changes

ICD-10 D59.19 is officially defined as "Other autoimmune hemolytic anemia." code D59.19 is referenced in 4 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D59.19 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 · 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.
Aetna · Identified Oct 4, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)
Aetna considers autologous hematopoietic cell transplantation medically necessary for adults 18 to 69 years old with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure. This applies when active interstitial lung disease is present with a forced vital capacity or diffusing capacity of the lung for carbon monoxide below 70% of predicted, or when previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, if there are none, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic hematopoietic cell transplantation experimental, investigational, or unproven for conditions including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, myasthenia gravis, type I diabetes mellitus, age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera, and thrombotic thrombocytopenic purpura.
Aetna · Identified Oct 2, 2026Medium impact
Hereditary Angioedema (CPB 0782, reviewed 2026-09-10)
Aetna Clinical Policy Bulletin 0782 sets the criteria for hereditary angioedema (HAE) drugs under commercial medical plans, and precertification is required for these agents in applicable plan designs. Cinryze, Dawnzera, Haegarda and Takhzyro are considered medically necessary for prevention of HAE attacks when they are prescribed by or in consultation with a prescriber who specializes in the management of HAE, are not used in combination with another prophylaxis medication, and the member meets the initial criteria, including C1 inhibitor deficiency confirmed by laboratory testing or a normal C1 inhibitor with a qualifying pathogenic variant or a family history of angioedema refractory to high-dose antihistamine therapy for at least one month. Berinert is considered medically necessary for treatment of acute attacks only when the member has a contraindication, intolerance or ineffective response to the equivalent alternative Ruconest, tried for one month, and all other indications of these agents are considered experimental, investigational or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)
Aetna's Clinical Policy Bulletin 0606 covers hematopoietic cell transplantation for autoimmune diseases and other listed conditions. Aetna considers autologous transplant medically necessary for adults aged 18 to 69 with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure when either active interstitial lung disease with an FVC or DLCO below 70% of predicted is present, or previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, where none exist, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic transplant experimental, investigational or unproven for many autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, type 1 diabetes and myasthenia gravis, and for miscellaneous conditions such as age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera and thrombotic thrombocytopenic purpura.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D59.19?

There are 4 tracked policy changes affecting code D59.19, including updates from Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D59.19?

Payers that have issued tracked updates for code D59.19 include: Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code D59.19 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D59.19. 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 D59.19?

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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Telehealth: Remote Patient Monitoring Services

Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)

Hereditary Angioedema (CPB 0782, reviewed 2026-09-10)

Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)

What insurance policy changes affect code D59.19?

Which payers have updated policy for code D59.19?

How do I get notified when code D59.19 policy changes?

Why do payers change policies for code D59.19?