D82.0 Insurance Policy Changes

ICD-10 D82.0 is officially defined as "Wiskott-Aldrich syndrome." code D82.0 is referenced in 9 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D82.0 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 Jul 16, 2026Medium impact
Allergy Testing 2.01.10
Percutaneous, combined percutaneous and intracutaneous, intracutaneous, patch, photo patch, photo, inhalation bronchial challenge, ingestion challenge, and gammaglobulin IgE tests are medically appropriate in the diagnosis of the allergic patient, with allergen-specific IgE medically appropriate only under specified circumstances. Allergen-specific IgG when the criteria are not met, the leukocyte histamine release test, ophthalmic and direct nasal mucous membrane tests, peanut allergen-specific ELISA testing, and cytotoxicity, provocative, and Rebuck skin window tests are investigational, and allergy testing for treatment programs such as tolerance induction programs is investigational. The July 16, 2026 update was an annual review with the policy intent unchanged.
Blue Cross & Blue Shield of Mississippi · Effective Jun 15, 2026Medium impact
Immunoglobulin Therapy
BCBSMS's Immunoglobulin Therapy policy states that prior authorization is required, and the 06/15/2026 update added Yimmugo to the products not covered on any BCBSMS Formulary. The same effective-dated update revised the medically necessary criteria for formulary intravenous and subcutaneous immunoglobulin therapy and changed the investigational list to specify sepsis in adults. Alyglo, Asceniv, Bivigam, Cuvitru, Flebogamma DIF, Gammagard S/D, Gammaplex, GamaSTAN, Hyqvia, Panzyga and Yimmugo are listed as not covered.
Aetna · Effective Apr 8, 2026Medium impact
Etuvetidigene Autotemcel (Waskyra) (CPB 1097, reviewed 2026-10-05)
Waskyra (etuvetidigene autotemcel) is a one-time autologous gene therapy that Aetna considers medically necessary for classic Wiskott-Aldrich syndrome when the initial approval criteria are met. Those criteria include age 6 months or older, a WAS gene pathogenic variant with absent or truncated WASP expression or a Zhu clinical score of 3 or higher, and no suitable HLA-identical sibling donor. Precertification is required of all Aetna participating providers and members in applicable plan designs. Gene and cellular therapies must be given at an Aetna Institutes GCIT Network unless the member's plan has elected not to require it. Aetna considers all other indications experimental, investigational or unproven.
Blue Cross Blue Shield of North Dakota · Effective Mar 17, 2026Medium impact
Pharmacy Policies Available Online
Commercial prior authorization medical drug policies have revisions effective March 17, 2026, with many policies adding the Appendix A NQTL Factor Checklist, showing the number of days allowed for authorization durations, and replacing 'coverage' with 'prior authorization validity' in the initial and renewal criteria. Clinical updates include Eylea HD for macular edema following retinal vein occlusion, Breyanzi for relapsed or refractory marginal zone lymphoma, and new appendiceal neoplasm and cancer indications with ICD-10 codes D37.3 and Z85.038. Commercial post service claim edit policies for Trogarzo have revisions effective Feb. 1, 2026.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02
Excellus medical policy 7.02.02 sets when allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered medically appropriate. It applies when the candidate meets the transplanting institution's selection criteria, the multidisciplinary team evaluates the individual and recommends treatment, and the individual is treated for one of the listed indications. The listed indications include acute and chronic leukemias, non-Hodgkin lymphoma, myelodysplastic diseases at intermediate or high risk, sickle cell anemia under stated criteria, transfusion-dependent thalassemia, bone marrow failure syndromes, severe combined immunodeficiency, hemophagocytic disorders, several storage and leukodystrophy disorders, and certain skeletal and metabolic bone disorders. Allo-HSCT is considered investigational for all other indications. The February 19, 2026 revision simplified the criteria to the indication level, removed the investigational indications list and added HCPCS code S2142.
Aetna · Identified Sep 30, 2026Medium impact
Etuvetidigene Autotemcel (Waskyra) (CPB 1097)
Aetna has issued a new Clinical Policy Bulletin (CPB 1097) establishing coverage criteria for Etuvetidigene Autotemcel (Waskyra), a gene therapy for Wiskott-Aldrich syndrome. This is a one-time autologous gene therapy requiring precertification through National Medical Excellence (NME) and administration at designated Aetna Institutes GCIT Network facilities. Billing teams must implement precertification workflows and ensure providers meet strict patient eligibility criteria before treatment.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders (CPB 0830, reviewed 2025-12-09)
Aetna considers allogeneic hematopoietic cell transplantation medically necessary for a list of primary immunodeficiency disorders, including adenosine deaminase deficiency, chronic granulomatous disease, common variable immune deficiency (CVID), DiGeorge syndrome, hemophagocytic lymphohistiocytosis, severe combined immunodeficiency (SCID), Wiskott-Aldrich syndrome, and others listed in the policy. Aetna considers hematopoietic cell transplantation experimental, investigational, or unproven for activated phosphoinositide 3-kinase delta syndrome, complement deficiency, granulomatous-lymphocytic interstitial lung disease, inflammatory bowel disease, juvenile idiopathic arthritis, and pulmonary alveolar proteinosis, and for autologous transplantation for primary immunodeficiency disorders. TREC testing is considered medically necessary following allogeneic hematopoietic stem cell transplant for SCID.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias
Allogeneic hematopoietic cell transplantation is considered medically necessary for select patients with sickle cell anemia (children or young adults with a prior stroke or an increased risk of stroke or end-organ damage), homozygous beta-thalassemia, aplastic anemia (hereditary or acquired), certain primary immunodeficiencies, lysosomal and peroxisomal storage disorders except Hunter, Sanfilippo, and Morquio syndromes, and infantile malignant osteopetrosis. No benefits are provided for a covered transplant procedure or a transplant evaluation unless the member receives prior authorization through case management from Blue Cross & Blue Shield of Mississippi.
Aetna · Identified Aug 13, 2026Low impact
Etuvetidigene Autotemcel (Waskyra) (CPB 1097, reviewed 08-2026-04)
Aetna's Clinical Policy Bulletin 1097 covers etuvetidigene autotemcel (Waskyra), a one-time gene therapy for Wiskott-Aldrich syndrome, for commercial medical plans. Aetna requires precertification and treats the therapy as medically necessary only when the patient meets the listed diagnosis, transplant candidacy and infection-screening criteria, and treats all other indications as experimental. The source states no effective date, so confirm the current policy before acting.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D82.0?

There are 9 tracked policy changes affecting code D82.0, including updates from Excellus BlueCross BlueShield, 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 D82.0?

Payers that have issued tracked updates for code D82.0 include: Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna, Blue Cross Blue Shield of North Dakota.

How do I get notified when code D82.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D82.0. 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 D82.0?

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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Allergy Testing 2.01.10

Immunoglobulin Therapy

Etuvetidigene Autotemcel (Waskyra) (CPB 1097, reviewed 2026-10-05)

Pharmacy Policies Available Online

Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02

Etuvetidigene Autotemcel (Waskyra) (CPB 1097)

Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders (CPB 0830, reviewed 2025-12-09)

Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias

Etuvetidigene Autotemcel (Waskyra) (CPB 1097, reviewed 08-2026-04)

What insurance policy changes affect code D82.0?

Which payers have updated policy for code D82.0?

How do I get notified when code D82.0 policy changes?

Why do payers change policies for code D82.0?