ICD-10 H49.811 is officially defined as "Kearns-Sayre syndrome, right eye." code H49.811 is referenced in 5 tracked payer policy changes from UnitedHealthcare and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H49.811 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
UnitedHealthcare's individual exchange botulinum toxin policy was revised effective November 1, 2026, which has already passed. The policy now applies in Massachusetts and New York, refers Nevada to the UnitedHealthcare Commercial version, and drops several diagnosis requirements for cervical dystonia, chronic anal fissures and detrusor overactivity, while HCPCS J0589 is now clarified for Daxxify and new eye-related ICD-10 codes were added for J0585 and J0586.
UnitedHealthcare and UMR updated the Botulinum Toxins A and B medical benefit drug policy, effective November 1, 2026, so the change is already in effect. It updates the list of ICD-10 diagnosis codes that apply to HCPCS codes J0585 and J0586 and adds a long run of eye diagnosis codes in the H49 and H50 series.
UnitedHealthcare Surest updated the approved ICD-10 diagnosis codes for botulinum toxin HCPCS codes J0585 and J0586, expanding coverage to include a comprehensive list of strabismus (H49.xx and H50.xx series) and ocular motility disorder codes. The policy also updated supporting clinical evidence and references. Effective November 1, 2026, billing teams must validate that botulinum toxin claims include only the newly approved diagnosis codes to avoid claim denials.
UnitedHealthcare updated its Botulinum Toxins A and B policy effective November 1, 2026, expanding the list of covered ICD-10 diagnosis codes for HCPCS codes J0585 and J0586. The update adds numerous eye muscle disorder codes (H49 and H50 series) and reflects current clinical evidence, FDA guidance, and CMS references. Billing teams must verify that claims for botulinum toxin injections include only the newly approved diagnosis codes to avoid denials.
Genetic testing to establish a genetic diagnosis of a mitochondrial disorder may be considered medically necessary when signs and symptoms of a mitochondrial disorder are present and the testing may eliminate the need for muscle biopsy. Targeted testing for a known familial variant in at-risk relatives may be considered medically necessary as preconceptional carrier testing when the family has a defined mitochondrial disorder of sufficient severity to impair quality of life or functional status and a known pathogenic variant was identified in the index case. Genetic testing for mitochondrial disorders is considered investigational in all other situations when the criteria for medical necessity are not met. The 02/12/2026 update removed ICD-9 diagnosis codes from the code reference and left the policy statements unchanged.
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