What insurance policy changes affect code D86.9?

There are 4 tracked policy changes affecting code D86.9, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D86.9?

Payers that have issued tracked updates for code D86.9 include: Aetna.

How do I get notified when code D86.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D86.9. 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 D86.9?

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.

PAYER POLICY CHANGES

D86.9 Insurance Policy Changes

ICD-10 D86.9 is officially defined as "Sarcoidosis, unspecified." code D86.9 is referenced in 4 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D86.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 10, 2026Medium impact
Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)
Aetna considers repository corticotropin injection (Acthar Gel only) medically necessary for infantile spasms in members less than 2 years of age, and considers all other indications experimental, investigational, unproven, or not medically necessary. Precertification of Acthar Gel or Purified Cortrophin Gel is required of all Aetna participating providers and members in applicable plan designs. Purified Cortrophin Gel is considered experimental, investigational, or unproven for infantile spasms because it is not FDA-approved, nor has a compendial use, for this indication, and use of Acthar Gel in combination with Purified Cortrophin Gel is considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Total Body Plethysmography (CPB 0474, reviewed 2026-07-17)
Aetna's Clinical Policy Bulletin 0474 covers total body plethysmography as an adjunct to complete pulmonary function testing, including residual volumes and diffusion, for these indications: determining bronchial hyper-reactivity in response to methacholine, histamine, or isocapnic hyperventilation; determining response to bronchodilators in persons who show a clinical response but no FEV1 improvement by spirometry; evaluating obstructive lung diseases such as bullous emphysema and cystic fibrosis; evaluating airflow resistance in obstructive processes where plethysmography is needed for accurate true lung volumes; measuring lung volumes to distinguish restrictive from obstructive processes when vital capacity is below 80% predicted on spirometry; and measuring lung volumes when multiple repeated trials are required or the subject cannot perform multi-breath tests. The policy considers total body plethysmography experimental, investigational, or unproven for all other indications, including screening asymptomatic persons with chronic obstructive pulmonary disease, pectus excavatum, primary pulmonary hypertension, monitoring bleomycin toxicity, scoliosis, and systemic sclerosis.
Aetna · Identified Aug 17, 2026Medium impact
Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction (CPB 0351, reviewed 2026-05-21)
Aetna considers flow cytometry for cell surface markers medically necessary for listed conditions, including abnormal tissue, bone marrow or blood histology suspicious for lymphoma, leukemia or myelodysplastic syndrome, multiple myeloma, paroxysmal nocturnal hemoglobinuria, primary immunodeficiencies, Sezary syndrome diagnosis, and T-cell monitoring for HIV infection and AIDS. Flow-cytometry-derived DNA ploidy or S-phase fraction is medically necessary only in localized cancers without metastatic disease, namely endometrial adenocarcinoma, gastric cancer, mediastinal neuroblastoma, medulloblastoma, ovarian carcinoma, partial hydatidiform mole, prostatic adenocarcinoma, renal cell adenocarcinoma and urinary bladder carcinoma, and only when the prognostic information will affect treatment decisions. Ektacytometry is medically necessary for red blood cell cytoskeleton and hydration disorders when red blood cell morphology does not provide a clear diagnosis. The red blood cell adhesion index for all indications, DNA ploidy or S-phase testing in breast, cervical, colorectal, non-small cell lung, small cell lung and pediatric intracranial tumors, and microfluidic flow adhesion assays for sickle cell disease are experimental, investigational or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)
Aetna considers certolizumab pegol (Cimzia) medically necessary for commercial medical plans only for members who have a contraindication, intolerance or ineffective response to the listed lower cost targeted immune modulators, with waived trial requirements for members who are pregnant or breastfeeding. Precertification is required of all Aetna participating providers and members in applicable plan designs, and the medication must be prescribed by or in consultation with a specialist such as a rheumatologist, gastroenterologist, dermatologist or oncologist depending on the indication. Aetna considers Cimzia experimental, investigational or unproven for concomitant use with other biologics or targeted synthetic drugs for the same indication and for Behcet's disease, microscopic colitis, ocular inflammation/uveitis, sarcoidosis and severe asthma.

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Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)

Total Body Plethysmography (CPB 0474, reviewed 2026-07-17)

Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction (CPB 0351, reviewed 2026-05-21)

Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)

What insurance policy changes affect code D86.9?

Which payers have updated policy for code D86.9?

How do I get notified when code D86.9 policy changes?

Why do payers change policies for code D86.9?