What insurance policy changes affect code E11.3599?

There are 3 tracked policy changes affecting code E11.3599, including updates from Aetna, 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 E11.3599?

Payers that have issued tracked updates for code E11.3599 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E11.3599 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E11.3599. 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 E11.3599?

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

E11.3599 Insurance Policy Changes

ICD-10 E11.3599 is officially defined as "Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye." code E11.3599 is referenced in 3 tracked payer policy changes from Aetna 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 E11.3599 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective Jul 16, 2025Medium impact
Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-10-05)
Aetna considers one intravitreal implant of Encelto (revakinagene taroretcel-lwey) per affected eye medically necessary for adults with idiopathic macular telangiectasia type 2 (MacTel) when the listed criteria are met, and considers all other indications experimental, investigational or unproven. The policy covers commercial medical plans, requires precertification in applicable plan designs, and requires that the drug be prescribed by or in consultation with an ophthalmologist. Members with intraretinal or subretinal neovascularization, anti-VEGF therapy within the past 3 months, glaucoma, uveitis, or current chemotherapy are listed as not eligible for the implant.
Aetna · Identified Aug 17, 2026Medium impact
ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)
Aetna considers the ADAMTS13 assay medically necessary for assessing prognosis in persons with thrombotic thrombocytopenic purpura (TTP), and for distinguishing hematopoietic stem cell transplant-associated thrombotic microangiopathy (HSCT-TMA, also called transplant-associated TMA) from TTP in persons with overlapping features when the test will be used to inform treatment. Aetna considers the assay experimental, investigational, or unproven for the uses it lists because of insufficient evidence, including sepsis-associated thrombotic microangiopathy, hemolytic uremic syndrome, acute myelogenous leukemia, colorectal cancer survival, COVID-19, cerebral infarction, and ADAMTS13 mutation testing for non-cirrhotic portal hypertension.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Retinal Telescreening for Diabetic Retinopathy
Retinal telescreening with digital imaging and manual grading of images may be considered medically necessary as a screening technique for the detection of diabetic retinopathy. Digital retinal imaging with image interpretation by FDA-approved artificial intelligence software, such as IDX-DR or EyeArt, may be considered medically necessary for screening for diabetic retinopathy. Retinal telescreening is considered investigational for all other indications, including the monitoring and management of disease in individuals diagnosed with diabetic retinopathy.

Watch E11.3599

Get one email when a payer policy names E11.3599, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-10-05)

ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)

Retinal Telescreening for Diabetic Retinopathy

What insurance policy changes affect code E11.3599?

Which payers have updated policy for code E11.3599?

How do I get notified when code E11.3599 policy changes?

Why do payers change policies for code E11.3599?