I06.2 Insurance Policy Changes

ICD-10 I06.2 is officially defined as "Rheumatic aortic stenosis with insufficiency." code I06.2 is referenced in 7 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I06.2 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Sep 10, 2026High impact
MA11.027h, Transcatheter Cardiac Valve Procedures
Independence Blue Cross updated MA11.027h to align TAVR coverage with CMS National Coverage Determination. Symptomatic severe aortic stenosis coverage changed from experimental/investigational (with CED exception) to medically necessary; asymptomatic aortic stenosis remains experimental/investigational except under CED. This expands coverage eligibility and requires billing teams to verify heart team documentation, FDA-approved valve systems, and specific clinical evaluations prior to claim submission.
Independence Blue Cross · Effective Jul 2, 2025Medium impact
MA11.027g, Transcatheter Cardiac Valve Procedures
Independence Blue Cross updated MA policy MA11.027g to MA11.027h, adding coverage for transcatheter tricuspid valve repair procedures (CPT codes 0569T and 0570T) under a Coverage with Evidence Development (CED) program, effective July 2, 2025. The policy was reissued on April 1, 2026 to communicate the company's continuing position on transcatheter cardiac valve procedures.
Independence Blue Cross · Effective Jul 2, 2025Medium impact
MA11.027g, Transcatheter Cardiac Valve Procedures
Independence Blue Cross has reissued MA11.027g (now superseded by MA11.027h) to communicate updated coverage criteria for transcatheter cardiac valve procedures, specifically adding CPT codes 0569T and 0570T for transcatheter edge-to-edge repair of tricuspid valve regurgitation under Medicare's Coverage with Evidence Development (CED) program effective 07/02/2025.
Aetna · Identified Aug 14, 2026Medium impact
Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)
Balloon valvuloplasty is medically necessary for severe rheumatic mitral stenosis, severe aortic stenosis, and pulmonary valve stenosis when the listed criteria are met. For mitral stenosis with favorable valve anatomy, the criteria include a cumulative echocardiographic score of 8 or less. Balloon dilation for all other indications not listed is experimental, investigational, or unproven, including balloon aortic valvuloplasty used to select transcatheter heart valve size and percutaneous balloon valvuloplasty for bioprosthetic tricuspid valve stenosis.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Transcatheter Aortic Valve Implantation for Aortic Stenosis
Transcatheter aortic valve replacement with an FDA-approved transcatheter heart valve system may be considered medically necessary for individuals with native valve aortic stenosis who have severe aortic stenosis with a calcified aortic valve, New York Heart Association Class II, III or IV heart failure symptoms, and no unicuspid or bicuspid aortic valves. Valve-in-valve replacement of a failed surgical bioprosthetic aortic valve may be considered medically necessary when the individual meets the policy's surgical risk criteria documented by at least 2 cardiovascular specialists, and use of a cerebral embolic protection device (e.g., Sentinel) during these procedures is considered investigational. The 08/13/2025 update changed the policy description regarding devices, and the policy statements are unchanged.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.02.25j, Transcatheter Cardiac Valve Procedures
Independence Blue Cross has reissued policy 11.02.25k for Transcatheter Cardiac Valve Procedures, superseding version 11.02.25j. The policy continues to cover TAVR for native valve aortic stenosis and degenerated bioprosthetic valves ('valve-in-valve') under specified clinical criteria. An ICD-10 code (Q23.88) was added in October 2024 for congenital malformations of aortic and mitral valves. No substantive coverage changes are documented; this is a routine policy reissuance communicating the company's continuing position.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.02.25j, Transcatheter Cardiac Valve Procedures
Independence Blue Cross reissued policy 11.02.25k for Transcatheter Cardiac Valve Procedures, maintaining the company's continuing position on TAVR coverage. The policy was updated to include new ICD-10 code Q23.88 (Other congenital malformations of aortic and mitral valves) effective 10/01/2024. No substantive changes to medical necessity criteria, coverage requirements, or billing codes occurred in the most recent 04/01/2026 reissuance.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I06.2?

There are 7 tracked policy changes affecting code I06.2, including updates from Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I06.2?

Payers that have issued tracked updates for code I06.2 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code I06.2 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I06.2. 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 I06.2?

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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MA11.027h, Transcatheter Cardiac Valve Procedures

MA11.027g, Transcatheter Cardiac Valve Procedures

MA11.027g, Transcatheter Cardiac Valve Procedures

Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)

Transcatheter Aortic Valve Implantation for Aortic Stenosis

11.02.25j, Transcatheter Cardiac Valve Procedures

11.02.25j, Transcatheter Cardiac Valve Procedures

What insurance policy changes affect code I06.2?

Which payers have updated policy for code I06.2?

How do I get notified when code I06.2 policy changes?

Why do payers change policies for code I06.2?