What insurance policy changes affect code E34.09?

There are 3 tracked policy changes affecting code E34.09, including updates from Presbyterian Health Plan, Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E34.09?

Payers that have issued tracked updates for code E34.09 include: Presbyterian Health Plan, Blue Cross Blue Shield of North Dakota, Aetna.

How do I get notified when code E34.09 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E34.09. 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 E34.09?

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

E34.09 Insurance Policy Changes

ICD-10 E34.09 is officially defined as "Other carcinoid syndrome." code E34.09 is referenced in 3 tracked payer policy changes from Presbyterian Health Plan, Blue Cross Blue Shield of North Dakota, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E34.09 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Presbyterian Health Plan · Effective Mar 3, 2026High impact
2026 March Network Connection
Effective March 3, 2026, prior authorization from Evolent is required before oncology chemotherapeutic drugs, supportive agents, symptom management medications and radiation oncology services are administered, for Presbyterian members of all ages with primary diagnoses in the range C00 to D49.9 or E34.0, E34.01 and E34.09. Presbyterian will stop creating secondary claims for dual coverage members on March 13, 2026, so providers will need to submit both primary and secondary claims. HCA is scheduled to go live with Turquoise Claims on March 23, 2026, and telehealth originating site fee Q3014 may only be billed by the eligible facility where the member is physically located.
Blue Cross Blue Shield of North Dakota · Effective Jan 13, 2026Medium impact
Pharmacy Policies Updates
BCBSND's Commercial post service claim edit medical drug policies have revisions effective Dec. 1, 2025, and its Commercial prior authorization medical drug policies have revisions effective Jan. 13, 2026. Most of these policies now separate Length of Authorization durations for initial and renewal periods, add the Appendix A Non-Quantitative Treatment Limitations (NQTL) Factor Checklist, and replace 'coverage' with 'prior authorization validity' in the initial and renewal criteria. Several policies also remove discontinued HCPCS codes, add ICD-10 covered diagnosis codes, and update oncology criteria to align with NCCN guidelines.
Aetna · Identified Aug 16, 2026Medium impact
Lutetium Lu 177 Dotatate (Lutathera) and Lutetium Lu 177 Vipivotide Tetraxetan (Pluvicto) (CPB 0929, reviewed 2026-07-17)
Aetna's policy covers lutetium Lu 177 dotatate (Lutathera) and lutetium Lu 177 vipivotide tetraxetan (Pluvicto) for commercial medical plans. Lutathera is medically necessary for four doses total for specified somatostatin receptor-positive neuroendocrine tumors, poorly controlled carcinoid syndrome, and pheochromocytoma/paraganglioma when the listed criteria are met, and Pluvicto is medically necessary for up to 6 total doses lifetime for PSMA-positive metastatic castration-resistant prostate cancer when all listed criteria are met. Aetna considers both drugs experimental, investigational, or unproven for all other indications, including Lutathera for medullary thyroid carcinoma and meningioma.

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2026 March Network Connection

Pharmacy Policies Updates

Lutetium Lu 177 Dotatate (Lutathera) and Lutetium Lu 177 Vipivotide Tetraxetan (Pluvicto) (CPB 0929, reviewed 2026-07-17)

What insurance policy changes affect code E34.09?

Which payers have updated policy for code E34.09?

How do I get notified when code E34.09 policy changes?

Why do payers change policies for code E34.09?