E28.2 Insurance Policy Changes

ICD-10 E28.2 is officially defined as "Polycystic ovarian syndrome." code E28.2 is referenced in 7 tracked payer policy changes from Horizon BCBS NJ, Capital Blue Cross, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E28.2 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Horizon BCBS NJ · Effective Jan 1, 2026High impact
Statin Use in Persons with Diabetes (SUPD)
This is a new Medicare Part D Star Ratings measure (SUPD) effective for 2026 that evaluates whether patients ages 40-75 with diabetes on antidiabetic medications are also receiving statin therapy. Billing teams must ensure proper documentation and ICD-10 coding of exclusionary diagnoses to accurately track eligible patients and avoid measure performance penalties. Claims must include appropriate exclusion codes when patients have contraindications to statin therapy.
Capital Blue Cross · Effective Apr 1, 2026Medium impact
AB2026-04-002 Medicare only
Capital Blue Cross updated Medicare Part D Star measures for 2026, adding new exclusions for Statin Use in Persons with Diabetes (SUPD) that recognize PCSK9 inhibitors and bempedoic acid as alternatives for patients who cannot tolerate statins. Providers must submit specific ICD-10-CM codes annually during in-person or audio/video visits to qualify patients for exclusions from the SUPD measure.
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.
Presbyterian Health Plan · Identified Jul 31, 2026Medium impact
2026 July Network Connection
CPT 90785 (interactive complexity) may be billed only as an add-on code that accompanies an eligible primary psychiatric service, and only when its specific criteria and requirements are met. Medical records must clearly support CPT 90785 by describing specific communication challenges, challenges affecting clinical interaction, the interactive methods used, and why standard communication approaches were insufficient, and claims submitted without adequate documentation may be subject to audit or review with payment adjusted if billing requirements are not met. Nail pathogen panel claims should be supported by clear clinical indication and medical necessity, prior testing and treatment history, a valid signed provider order specifying test type, and accurate diagnosis coding, and the Presbyterian Program Integrity Department performs random claims validation audits.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Luteinizing Hormone (LH) Testing
Measurement of luteinizing hormone is medically necessary to distinguish between pituitary, hypothalamus and gonad disorders in males with hypogonadism or hypergonadism. It is also medically necessary for females with symptoms of ovarian dysfunction. Measurement of luteinizing hormone is not medically necessary when performed for screening in asymptomatic patients.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Free Testosterone Testing
Serum free testosterone (CPT 84402) is medically necessary to distinguish a sex hormone-binding globulin (SHBG) abnormality from hypogonadism in obese males with symptoms of hypogonadism when total testosterone is low, to diagnose hyperandrogenism in symptomatic females, and in patients with a medical diagnosis that may increase or decrease SHBG levels. It is not medically necessary to diagnose testosterone deficiency in non-obese males with symptoms of hypogonadism, or when performed for screening of asymptomatic patients. Free testosterone should be performed by equilibrium dialysis, and free testosterone measured by an analog method should never be ordered.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Estrogen Hormone Testing: Estradiol and Estrone
Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism, to diagnose hyperestrogenism in symptomatic males, to monitor hormone replacement therapy in postmenopausal females, and to monitor antiestrogen therapy. Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients. The covered tests are total estradiol (CPT 82670), fractionated estrogens (CPT 82671), total estrogens (CPT 82672), estrone (CPT 82679), and free estradiol by direct measurement, such as equilibrium dialysis (CPT 82681).

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E28.2?

There are 7 tracked policy changes affecting code E28.2, including updates from Horizon BCBS NJ, Capital Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E28.2?

Payers that have issued tracked updates for code E28.2 include: Horizon BCBS NJ, Capital Blue Cross, Aetna, Presbyterian Health Plan, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E28.2 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E28.2. 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 E28.2?

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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Statin Use in Persons with Diabetes (SUPD)

AB2026-04-002 Medicare only

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

2026 July Network Connection

Luteinizing Hormone (LH) Testing

Free Testosterone Testing

Estrogen Hormone Testing: Estradiol and Estrone

What insurance policy changes affect code E28.2?

Which payers have updated policy for code E28.2?

How do I get notified when code E28.2 policy changes?

Why do payers change policies for code E28.2?