E88.01 Insurance Policy Changes

ICD-10 E88.01 is officially defined as "Alpha-1-antitrypsin deficiency." code E88.01 is referenced in 15 tracked payer policy changes from UnitedHealthcare, Blue Cross Blue Shield of Rhode Island, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E88.01 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

UnitedHealthcare · Effective Dec 1, 2026Medium impact
Alpha1-Proteinase Inhibitors
Effective 2026-12-01, the UnitedHealthcare Community Plan of Indiana Medicaid medical benefit drug policy for Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) now covers these products as proven and medically necessary for chronic augmentation and maintenance therapy in patients with emphysema due to congenital alpha1-antitrypsin deficiency, with initial authorization and reauthorization each limited to no more than 12 months. The policy also removes language saying it did not apply to Indiana, adds ICD-10 code E88.01, and continues to list cystic fibrosis and conditions other than AAT-associated emphysema as unproven.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2026High impact
Medical policy updates
Blue Cross Blue Shield Rhode Island is implementing major policy changes effective January 1, 2026, including new prior authorization requirements for physical therapy after 14 visits, removing prior authorization from numerous cardiology/radiology procedures, and updating coverage for various genetic testing and specialty procedures. Multiple CPT codes are changing authorization status and coverage requirements across Medicare Advantage and commercial plans.
Aetna · Identified Oct 29, 2026Medium impact
Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-10-26)
This Aetna Clinical Policy Bulletin (CPB 0690) addresses noninvasive tests for hepatic fibrosis and lists which tests Aetna considers medically necessary and which it considers experimental, investigational, or unproven. Aetna considers transient elastography (e.g., FibroScan) medically necessary for follow-up of primary sclerosing cholangitis, monitoring of liver function in Wilson's disease, and distinguishing hepatic cirrhosis from non-cirrhosis in persons with hepatitis B, hepatitis C or other chronic liver diseases. Performing transient elastography, magnetic resonance elastography, the Enhanced Liver Fibrosis (ELF) test, or FibroTest-ActiTest/HCV-FibroSure more than twice per year is considered not medically necessary.
Aetna · Identified Oct 6, 2026Medium impact
Liver Transplantation (CPB 0596, reviewed 2026-09-08)
Aetna considers orthotopic liver transplantation medically necessary for members with end-stage liver disease from the listed conditions who meet the criteria below. Adolescents 12 years of age or older and adults qualify with a MELD score greater than 10, approval by the UNOS Regional Review Board, or when they meet the transplant institution's selection criteria, and children under 12 qualify when they meet the transplanting institution's selection criteria. Liver transplantation is not medically necessary for absolute contraindications including active sepsis outside the biliary tract, inability to adhere to the transplant regimen (including homelessness, active substance abuse, and unstable psychiatric disease or psychosocial problem), presence of other effective treatments or surgical options, and significant organ system failure other than kidney, liver or small bowel.
Aetna · Identified Oct 6, 2026Medium impact
Lung Transplantation (CPB 0598, reviewed 2026-09-08)
Aetna considers lung transplantation medically necessary for qualifying conditions including cystic fibrosis, emphysema and alpha-1-antitrypsin deficiency, Eisenmenger's complex, primary pulmonary hypertension, pulmonary fibrosis, sarcoidosis, lymphangioleiomyomatosis with end-stage pulmonary disease, bronchopulmonary dysplasia, and graft-versus-host disease or failed primary lung graft, when the member meets the transplanting institution's selection criteria or, without those criteria, the general and disease-specific criteria in the policy. Cystic fibrosis requires at least 2 listed signs of clinical deterioration, such as decreasing FEV1, FEV1 less than 30% predicted, or recurrent massive hemoptysis, and emphysema requires both hospitalization for COPD exacerbation with hypercapnia in the preceding year and a BODE index of 7 or above. Lung transplantation is considered not medically necessary for malignancy involving the lung, multi-system disease, refractory uncontrolled hypertension, other effective treatments being available, and smoking without 6 months of abstinence.
Aetna · Identified Oct 4, 2026Medium impact
Genetic Testing (CPB 0140, reviewed 2026-08-18)
Aetna covers genetic testing only when the criteria for the specific condition are met, and it considers testing outside those criteria experimental, investigational, or unproven, including testing for Parkinson disease, essential tremor, coronary artery disease (except testing for familial hypercholesterolemia), and type 2 diabetes other than MODY. Multi-gene panels for inherited cancers are covered only for members with a personal or family history of a related cancer when more than one inherited cancer syndrome could explain the presentation and the panel is more efficient than separate tests, and genetic testing for inherited cancers is a once-in-a-lifetime benefit. Expanded carrier screening for people who are pregnant or planning a pregnancy is covered when the panel includes cystic fibrosis, spinal muscular atrophy, and/or hemoglobinopathies, unless previously performed, and the results will be used in managing the pregnancy or for family planning; whole exome or whole genome sequencing is covered for an unexplained congenital or neurodevelopmental disorder when its listed criteria are met, and whole genome sequencing after a non-diagnostic whole exome test is considered not medically necessary.
Aetna · Identified Aug 19, 2026Medium impact
Lung Transplantation (CPB 0598, reviewed 2025-12-02)
Aetna considers lung transplantation medically necessary for qualifying conditions, including cystic fibrosis, emphysema including alpha-1-antitrypsin deficiency, pulmonary fibrosis, pulmonary hypertension, Eisenmenger's complex, sarcoidosis, lymphangioleiomyomatosis, bronchopulmonary dysplasia and graft-versus-host disease, for members who meet the transplanting institution's selection criteria or, where there are none, the general and disease-specific selection criteria. Lung transplantation is considered not medically necessary for contraindications including lung malignancy, multi-system disease, acute or chronic active infection not adequately treated, and smoking, since members with a history of smoking must be abstinent for 6 months before being considered eligible. Lobar lung transplantation, anti-thymocyte globulin for acute cellular rejection and ex vivo lung perfusion for preservation and transplant of donor lungs are considered medically necessary, while AlloSure, Prospera Lung and lung xenotransplantation are considered experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-06-18)
Aetna's Clinical Policy Bulletin 0690 on noninvasive tests for hepatic fibrosis, reviewed 2026-06-18, states which tests it considers medically necessary and which it considers experimental, investigational or unproven. Aetna considers transient elastography (e.g., FibroScan), FibroTest-ActiTest/HCV-FibroSure, magnetic resonance elastography and the Enhanced Liver Fibrosis (ELF) test medically necessary for the indications listed, and considers baseline liver elastography medically necessary for persons with cystic fibrosis who have hepatobiliary involvement. Each of the four tests is considered not medically necessary if performed more than twice per year. Transient elastography and FibroTest-ActiTest/HCV-FibroSure are considered not medically necessary within 6 months of a liver biopsy or of each other, and magnetic resonance elastography and ELF are considered not medically necessary within 6 months of a liver biopsy or another test for liver fibrosis. ARFI, LiverMultiScan, artificial intelligence for NAFLD, NASHnext and the OWLiver Panel are listed as experimental, investigational or unproven for the uses the policy names.
Aetna · Identified Aug 17, 2026Medium impact
Alpha1-Proteinase Inhibitors (CPB 0145, reviewed 2026-03-24)
Aetna covers Aralast NP, Glassia, Prolastin-C and Zemaira for emphysema caused by alpha1-antitrypsin deficiency when the member's pretreatment serum AAT level is below 11 micromol/L, the pretreatment post-bronchodilation FEV1 is 25% to 80% of predicted, and the member has a PiZZ, PiZ (null) or Pi (null, null) genotype or another phenotype or genotype linked to that serum level, without PiMZ or PiMS. Aetna also covers these products for steroid-refractory acute graft-versus-host disease following hematopoietic stem cell transplantation, and continues emphysema treatment when the member shows a beneficial clinical response. Aetna considers all other indications experimental, investigational or unproven and requires precertification for these products in applicable plan designs.
Aetna · Identified Aug 17, 2026Medium impact
Lung Denervation Therapy and Lung Volume Reduction Surgery (CPB 0160, reviewed 2026-03-26)
Aetna Clinical Policy Bulletin 0160, last reviewed 03/26/2026, sets medical necessity criteria for lung volume reduction surgery (LVRS), bullectomy and FDA-approved endobronchial valves for severe emphysema. Aetna considers LVRS medically necessary when the member meets the listed selection criteria, including FEV1 less than or equal to 45% of predicted, a six-minute walk test greater than 140 meters, and CT scan evidence of bilateral emphysema. Thoracoscopic laser bullectomy, bronchoscopic thermal vapor ablation, biologic lung volume reduction and targeted lung denervation (the dNerva Lung Denervation System) are considered experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Pulmonary Rehabilitation (CPB 0032, reviewed 2026-03-05)
Aetna considers entry into a medically supervised outpatient pulmonary rehabilitation program medically necessary when the member has a chronic pulmonary disease or another condition that affects pulmonary function, dyspnea at rest or with exertion, reduced exercise tolerance that restricts activities of daily living or work, symptoms that persist despite appropriate medical management, and a moderate to severe functional pulmonary disability. That disability is shown either by a maximal exercise stress test with VO2max of 20 ml/kg/min or less (about 5 METS) or by FEV1, FVC, FEV1/FVC, or DLCO below 60 % of predicted, and the member must be physically able, motivated, and willing to participate. A typical course extends for up to 6 weeks or 36 hours of therapy. Repeat programs are considered not medically necessary, except in connection with lung transplantation or lung volume reduction surgery, and routine, maintenance, or non-skilled care is considered not medically necessary. Pulmonary rehabilitation is considered experimental, investigational, or unproven for all other indications.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Genetic Testing for Alpha-1 Antitrypsin Deficiency
Genetic testing for alpha-1 antitrypsin deficiency may be considered medically necessary when the individual is suspected of having the condition because of clinical factors, or may be at high risk because of a first-degree relative with AAT deficiency. It may also be considered medically necessary when the individual has a serum alpha1-antitrypsin level in the range of severe deficiency. Genetic testing is considered investigational in all other situations.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
State and School Employees' Health Insurance Plan - Alpha-1 Proteinase Inhibitors
Alpha-1 proteinase inhibitors (Aralast NP, Glassia, Prolastin-C, and Zemaira) may be considered medically necessary for members 18 years of age or older with alpha-1 antitrypsin deficiency and clinically evident emphysema who meet the listed criteria. These include a pre-treatment serum alpha-1 antitrypsin level below 11µM/L and a baseline FEV1 of 65% or less of predicted, or a baseline FEV1 above 65% with rapid decline in lung function. Renewal requires prior approval through the Blue Cross & Blue Shield of Mississippi review process and documented clinical improvement. The most recent review, dated 02/24/2026, updated the policy description and left the policy statements unchanged.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Alpha-1 Proteinase Inhibitors
Prior authorization is required for the alpha-1 proteinase inhibitors Aralast NP, Glassia, Prolastin-C, and Zemaira. Initial medical necessity requires all of the following: age 18 or older, alpha-1 antitrypsin deficiency with clinically evident emphysema, pre-treatment serum alpha-1 antitrypsin below 11 uM/L, no PI*MZ genotype (documentation required), no IgA deficiency with serum antibodies against IgA, and either baseline FEV1 of 65% or less of predicted or a baseline FEV1 above 65% with rapid decline (change greater than 120 mL/year). Approval length is 12 months.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Lung and Lobar Lung Transplant
Lung transplantation may be considered medically necessary for carefully selected individuals with irreversible, progressively disabling, end-stage pulmonary disease unresponsive to maximum medical therapy. A lobar lung transplant from a living or deceased donor may be considered medically necessary for carefully selected individuals with end-stage pulmonary disease, including conditions such as bilateral bronchiectasis, alpha-1 antitrypsin deficiency, and cystic fibrosis (both lungs to be transplanted). Lung or lobar retransplantation after a failed transplant may be considered medically necessary for individuals who meet criteria, and all other situations are investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E88.01?

There are 15 tracked policy changes affecting code E88.01, including updates from UnitedHealthcare, Blue Cross Blue Shield of Rhode Island, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E88.01?

Payers that have issued tracked updates for code E88.01 include: UnitedHealthcare, Blue Cross Blue Shield of Rhode Island, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E88.01 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E88.01. 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 E88.01?

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.

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Alpha1-Proteinase Inhibitors

Medical policy updates

Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-10-26)

Liver Transplantation (CPB 0596, reviewed 2026-09-08)

Lung Transplantation (CPB 0598, reviewed 2026-09-08)

Genetic Testing (CPB 0140, reviewed 2026-08-18)

Lung Transplantation (CPB 0598, reviewed 2025-12-02)

Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-06-18)

Alpha1-Proteinase Inhibitors (CPB 0145, reviewed 2026-03-24)

Lung Denervation Therapy and Lung Volume Reduction Surgery (CPB 0160, reviewed 2026-03-26)

Pulmonary Rehabilitation (CPB 0032, reviewed 2026-03-05)

Genetic Testing for Alpha-1 Antitrypsin Deficiency

State and School Employees' Health Insurance Plan - Alpha-1 Proteinase Inhibitors

Alpha-1 Proteinase Inhibitors

Lung and Lobar Lung Transplant

What insurance policy changes affect code E88.01?

Which payers have updated policy for code E88.01?

How do I get notified when code E88.01 policy changes?

Why do payers change policies for code E88.01?