E11.622 Insurance Policy Changes

ICD-10 E11.622 is officially defined as "Type 2 diabetes mellitus with other skin ulcer." code E11.622 is referenced in 5 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 E11.622 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 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.
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.
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 E11.622?

There are 5 tracked policy changes affecting code E11.622, 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 E11.622?

Payers that have issued tracked updates for code E11.622 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E11.622 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E11.622. 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 E11.622?

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)

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

Hyperbaric Oxygen Therapy

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

What insurance policy changes affect code E11.622?

Which payers have updated policy for code E11.622?

How do I get notified when code E11.622 policy changes?

Why do payers change policies for code E11.622?