I01.1 Insurance Policy Changes

ICD-10 I01.1 is officially defined as "Acute rheumatic endocarditis." code I01.1 is referenced in 3 tracked payer policy changes from Excellus BlueCross BlueShield and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I01.1 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 Oct 22, 2026Medium impact
Cardiac Rehabilitation 8.01.14
Excellus BlueCross BlueShield policy 8.01.14 covers monitored Phase I and Phase II cardiac rehabilitation (CR) for acute myocardial infarction, percutaneous coronary intervention, coronary bypass surgery, and heart transplantation within the preceding 12 months, and for Class II or higher congestive heart failure, stable angina pectoris, and valvular disease. Additional CR services are considered medically appropriate after another qualifying cardiac event, such as another documented MI, another cardiovascular surgery or percutaneous intervention, or new clinically significant coronary lesions documented by cardiac catheterization. Phase III maintenance programs are considered not medically necessary, and intensive cardiac rehabilitation programs, including the Ornish Program, the Pritikin Program and the Benson-Henry Institute Cardiac Wellness Program, are considered investigational for all indications. The 10/22/26 revision is an annual update, and the policy intent is unchanged.
Aetna · Identified Sep 30, 2026Medium impact
Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-08-25)
Aetna considers transcatheter edge-to-edge repair with an FDA-approved device, such as the MitraClip NTR/XTR Clip Delivery System, medically necessary for chronic mitral regurgitation that remains symptomatic despite maximal doses of medical therapy in members with symptomatic severe primary mitral regurgitation who are not considered good candidates for mitral valve surgery, or with symptomatic severe secondary mitral regurgitation who have a left ventricular ejection fraction between 20% and 50%, a left ventricular end-systolic diameter of 70 mm or less, and a pulmonary artery systolic pressure of 70 mmHg or less. Transcatheter mitral valve-in-valve replacement with an FDA-approved device, such as the Edwards-Sapien 3 valve, is considered medically necessary for symptomatic failing surgical bioprosthetic mitral valves when a heart team including a cardiac surgeon judges the member to be at high or greater risk for open surgical therapy, meaning a predicted risk of surgical mortality of 8% or higher at 30 days. Transcatheter edge-to-edge repair with the TriClip device is considered medically necessary for severe tricuspid regurgitation with symptomatic heart failure when all listed criteria are met, while caval valve implantation, transcatheter tricuspid valve replacement, and trans-apical mitral valve repair are considered experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-06-05)
Aetna covers transcatheter mitral valve repair with an FDA-approved device such as the MitraClip for members with chronic mitral regurgitation who remain symptomatic despite maximal doses of medical therapy and meet the listed primary or secondary regurgitation criteria. Transcatheter tricuspid valve repair with the TriClip device is covered only for members with severe tricuspid regurgitation, symptomatic heart failure NYHA class II, III, or IVa, and the other listed criteria, and tricuspid valve repair that does not meet these criteria is considered experimental, investigational, or unproven. Mitral valve-in-valve replacement with the Edwards-Sapien 3 valve is covered for symptomatic failing surgical bioprosthetic mitral valves in members a heart team judges to be at high or greater risk for open surgery.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I01.1?

There are 3 tracked policy changes affecting code I01.1, including updates from Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I01.1?

Payers that have issued tracked updates for code I01.1 include: Excellus BlueCross BlueShield, Aetna.

How do I get notified when code I01.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I01.1. 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 I01.1?

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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Cardiac Rehabilitation 8.01.14

Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-08-25)

Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-06-05)

What insurance policy changes affect code I01.1?

Which payers have updated policy for code I01.1?

How do I get notified when code I01.1 policy changes?

Why do payers change policies for code I01.1?