E11.621 Insurance Policy Changes

ICD-10 E11.621 is officially defined as "Type 2 diabetes mellitus with foot ulcer." code E11.621 is referenced in 9 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E11.621 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 Jan 22, 2026Medium impact
Platelet Rich Plasma and Growth Factor Treatments 2.01.24
Policy 2.01.24, Platelet Rich Plasma and Growth Factor Treatments, states that platelet-rich plasma (PRP) and autologous platelet-derived preparations, including basic fibroblast growth factor, epidermal growth factor, and placental angiogenic growth factors, are investigational for all indications. The 01/22/26 annual update changed the policy title and deleted the policy statements for becalpermin gel. The policy also states that the AAOS guidelines for osteoarthritis of the hip and glenohumeral joint, and for rotator cuff injuries, do not recommend PRP for these conditions.
Aetna · Identified Oct 17, 2026Medium impact
Electrical Stimulation for Chronic Ulcers (CPB 0680, reviewed 2026-10-14)
Aetna considers electrical stimulation medically necessary durable medical equipment for arterial ulcers, diabetic ulcers, Stage III or IV pressure ulcers, and venous stasis ulcers when it is used as adjunctive therapy after no measurable signs of healing for at least 30 days of conventional wound treatment. Courses exceeding 1 hour per day are not considered medically necessary, continued stimulation is not medically necessary if measurable healing is not shown within a 4-week treatment period or once the wound bed is 100% epithelialized, and electrical stimulation for chronic ulcers in the home setting is considered not medically appropriate. Aetna considers electrical stimulation experimental, investigational, or unproven for uses including prevention of ulcers and pressure sores, infected wounds, microcurrent as an adjunctive therapy, and the VeinoPlus device for venous ulcers.
Aetna · Identified Aug 16, 2026Medium impact
Skin and Soft Tissue Substitutes (CPB 0244, reviewed 2026-07-29)
Aetna's Clinical Policy Bulletin 0244 sets the coverage rules for skin and soft tissue substitutes used on chronic wounds. Aetna considers these products medically necessary for chronic wounds that failed to respond to treatment when the member is 18 or older, is a non-smoker or has completed or is enrolled in smoking cessation therapy, and the wound is a partial- or full-thickness skin defect of at least 1 cm2 that has not improved after at least four weeks of standard wound care. Diabetic foot ulcers, venous leg ulcers and partial- or full-thickness burn wounds have additional criteria, each listed product has its own indications, and pressure ulcer treatment and other uses are considered not medically necessary, experimental, investigational or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Near-Infrared (NIR) Spectroscopy (CPB 0796, reviewed 2025-11-19)
Aetna's Clinical Policy Bulletin 0796 considers near-infrared (NIR) spectroscopy experimental, investigational or unproven for a long list of indications, including monitoring cerebral perfusion during cardiac and non-cardiac surgery, use in the intensive care and neonatal intensive care settings, evaluating dementia, diagnosing mood disorders and schizophrenia, assessing pain, and treatment of restless legs syndrome. The policy also considers NIR intravascular ultrasound coronary imaging (for example the InfraReDx LipiScan IVUS Imaging System) experimental for all indications. It considers NIR spectroscopy using spatial frequency domain imaging (for example the Ox-Imager CS device) unproven for identifying and evaluating vascular tissue compromise and for all other indications, because there is a lack of clinical studies demonstrating that this approach improves clinical outcomes. Non-contact NIR spectroscopy (for example SnapshotNIR) is considered unproven for intra-operative wound assessment and all other indications because of insufficient evidence of its effectiveness.
Aetna · Identified Aug 13, 2026Medium impact
Phonophoresis (CPB 0210, reviewed 2026-03-27)
Aetna considers phonophoresis experimental, investigational, or unproven for all indications, including adhesive capsulitis, carpal tunnel syndrome, knee osteoarthritis, low back pain, neck pain, sinusitis, chronic obstructive pulmonary disease, and venous and diabetic ulcers, because its effectiveness has not been established. Controlled clinical trials have failed to demonstrate that phonophoresis increases the rate or extent of absorption of analgesics and anti-inflammatory agents. Bee venom phonophoresis and Contractubex phonophoresis are listed as not covered for the indications in the policy.
Aetna · Identified Aug 12, 2026Medium impact
Blood and Adipose Tissue Derived Products for Selected Indications (CPB 0784, reviewed 2025-11-19)
Clinical Policy Bulletin 0784 considers the following experimental, investigational, or unproven because their effectiveness has not been established: autologous blood injection and platelet-poor or platelet-rich plasma injection for all indications, plus specific listed uses of autologous platelet gel, adipose-tissue-derived stem cell injections, autologous fat injection and other blood-derived products. Listed uses include platelet-rich plasma for rotator cuff injuries, osteoarthritis and plantar fasciitis, autologous platelet gel after total knee arthroplasty and for diabetic foot ulcer, and autologous fat injection for carpometacarpal arthritis of the thumb and velopharyngeal insufficiency. The policy also lists CPT, HCPCS and ICD-10 codes as not covered for the indications it lists.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hyperbaric Oxygen Therapy
Systemic hyperbaric oxygen pressurization may be considered medically necessary for non-healing diabetic wounds of the lower extremities that meet all three criteria, acute traumatic ischemia, decompression sickness, acute gas embolism, acute cyanide poisoning, acute carbon monoxide poisoning, soft-tissue radiation necrosis and osteoradionecrosis, pre- and post-treatment for dental surgery (non-implant related) of an irradiated jaw, gas gangrene, profound anemia with exceptional blood loss when transfusion is impossible or must be delayed, and chronic refractory osteomyelitis. Topical hyperbaric oxygen therapy is considered investigational. Systemic hyperbaric oxygen pressurization is considered investigational in all other situations, including compromised skin grafts or flaps, acute osteomyelitis, acute thermal burns, acute surgical and traumatic wounds, and chronic wounds other than diabetic wounds that meet the stated criteria.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Bioengineered Skin and Soft Tissue Substitutes
Several listed tissue-engineered skin substitutes may be considered medically necessary for specific uses, including breast reconstruction with listed acellular dermal matrix products, chronic noninfected full-thickness diabetic lower-extremity ulcers, chronic venous insufficiency ulcers that have not adequately responded to a 1-month period of conventional ulcer therapy, dystrophic epidermolysis bullosa, and second- and third-degree burns. All other uses of the listed products, and all other skin and soft tissue substitutes not listed, are considered investigational. Code reference updates dated 07/01/2026, 08/15/2026 and 10/01/2026 add CPT 1045T through 1049T, HCPCS C9353 and C9361, and HCPCS A2046, A2047, A2048 and A2050 as investigational codes.
Aetna · Identified Sep 29, 2026Low impact
Bio-Surgery: Medicinal Leech Therapy and Medical Maggots (CPB 0556, reviewed 2026-09-01)
Aetna's bio-surgery policy (CPB 0556, reviewed September 1, 2026) sets when medicinal leech therapy and medical maggots (bagged larval therapy) are covered, mainly for specific chronic wounds, flap and replant salvage. It lists many other uses, including knee and thumb osteoarthritis, low back pain and burns, as experimental, and the source gives a review date but no effective date.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E11.621?

There are 9 tracked policy changes affecting code E11.621, including updates from Excellus BlueCross BlueShield, 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 E11.621?

Payers that have issued tracked updates for code E11.621 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E11.621 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E11.621. 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 E11.621?

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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Platelet Rich Plasma and Growth Factor Treatments 2.01.24

Electrical Stimulation for Chronic Ulcers (CPB 0680, reviewed 2026-10-14)

Skin and Soft Tissue Substitutes (CPB 0244, reviewed 2026-07-29)

Near-Infrared (NIR) Spectroscopy (CPB 0796, reviewed 2025-11-19)

Phonophoresis (CPB 0210, reviewed 2026-03-27)

Blood and Adipose Tissue Derived Products for Selected Indications (CPB 0784, reviewed 2025-11-19)

Hyperbaric Oxygen Therapy

Bioengineered Skin and Soft Tissue Substitutes

Bio-Surgery: Medicinal Leech Therapy and Medical Maggots (CPB 0556, reviewed 2026-09-01)

What insurance policy changes affect code E11.621?

Which payers have updated policy for code E11.621?

How do I get notified when code E11.621 policy changes?

Why do payers change policies for code E11.621?