I25.119 Insurance Policy Changes

ICD-10 I25.119 is officially defined as "Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris." code I25.119 is referenced in 8 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I25.119 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
Computed Tomography to Detect Coronary Artery Calcification
The policy history dates the latest update 11/01/2026. Coronary artery calcium scoring may be considered medically necessary once every 5 years when either of two conditions is met: it is an adjunct to standard cardiovascular risk assessment in asymptomatic adults without known coronary artery disease, or the individual has clinical atherosclerotic cardiovascular disease, is at least 40 years of age, has borderline to intermediate 10-year ASCVD risk, and is not currently on lipid-lowering therapy. AI-based automated detection, quantification or scoring of coronary artery calcium on chest CT is investigational, and the use of CT to detect coronary artery calcification is investigational for all other indications.
Excellus BlueCross BlueShield · Effective May 15, 2026Medium impact
Computed Tomography (CT) for Coronary Calcium Scoring 6.01.13
Effective May 15, 2026, Excellus BCBS policy 6.01.13 considers CT calcium scoring medically necessary to evaluate radiation-induced coronary artery disease when all conditional indications are met. The 01/22/26 update added the requirement that there has been no prior calcium score greater than zero. The conditional indications also require no symptoms suspicious for ischemia, no clinical history of CAD, no prior cardiac imaging documenting CAD, and at least five years since the last radiotherapy for the initial study or since the last CT calcium scoring for subsequent testing. CT calcium scoring is not medically appropriate for evaluating CAD in symptomatic individuals or for individuals with known CAD.
Aetna · Identified Aug 18, 2026Medium impact
Intravascular Optical Coherence Tomography (CPB 0829, reviewed 2026-04-27)
Aetna considers intravascular optical coherence tomography (OCT) medically necessary for procedural guidance to reduce ischemic events in members with acute coronary syndrome (ACS) undergoing coronary stent implantation in the left main artery or in complex lesions. Aetna considers intravascular OCT experimental, investigational, or unproven for all other indications, including carotid artery stenosis/stroke risk, intracranial aneurysm diagnosis and rupture assessment, pulmonary artery thrombus, cardiac allograft vasculopathy, follow-up evaluation of post-stent placement, guidance of percutaneous treatment of coronary bifurcation disease, and follow-up evaluation of renal arteries after radiofrequency catheter-based renal denervation. This policy was last reviewed 04/27/2026.
Aetna · Identified Aug 15, 2026Medium impact
Enhanced External Counterpulsation (EECP) (CPB 0262, reviewed 2026-05-14)
Aetna considers EECP medically necessary for chronic stable angina as a single course of 35 treatment hours (CPT 92971 or HCPCS G0166) for members with disabling Canadian Cardiovascular Society Class III or IV angina who are refractory to maximum medical therapy and not readily amenable to PTCA or cardiac bypass. A repeat course is medically necessary when the member still meets the single-course criteria, prior EECP produced a sustained improvement (a greater than 25% reduction in anginal frequency or an improvement of one or more anginal classes), and at least three months have elapsed since the prior treatment. Hydraulic versions of these devices are considered not medically necessary, and EECP is considered experimental, investigational or unproven for conditions such as heart failure, erectile dysfunction, stroke, long COVID, microvascular angina and restless leg syndrome.
Aetna · Identified Aug 13, 2026Medium impact
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-02-19)
Aetna Clinical Policy Bulletin 0558 considers percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion medically necessary for hypertrophic obstructive cardiomyopathy (HOCM) in adults 21 years of age and older when all listed criteria are met, including severe symptoms despite optimal drug therapy, NYHA class III or IV, a peak LVOT gradient of at least 50 mm Hg, and suitable coronary anatomy with an identifiable septal perforator artery. Aetna also considers PTSMA medically necessary for carefully selected members 5 to 20 years of age with HOCM when the pediatric criteria are met, and it considers PTSMA for all other indications, SESAME, and ultrasound-guided PTSMA experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Coronary Computed Tomography Angiography with Selective Noninvasive Fractional Flow Reserve
Noninvasive fractional flow reserve following a positive coronary computed tomography angiography may be considered medically necessary to guide decisions about invasive coronary angiography for individuals with stable chest pain and intermediate risk of coronary artery disease (suspected or presumed stable ischemic heart disease). Noninvasive fractional flow reserve that does not meet these criteria is considered investigational. The 10/16/2026 update revised the policy description regarding the Heartflow Analysis and made minor changes to the medically necessary statement.
Blue Cross of Idaho · Identified Jun 19, 2026Medium impact
One-to-One for Healthcare Professionals - Fall Edition
Blue Cross of Idaho scheduled the third phase of its claims processing system update for January 1, 2024, moving Individual and government lines, including Medicare Advantage, Medicare Supplement, MMCP and Idaho Medicaid Plus, to the Gemstone system, and Legacy will be sunset by the end of 2026. Effective October 1, 2023, bariatric surgery was changed to not medically necessary for individuals with a BMI less than 35 kg/m2 who do not have diabetes and for all individuals with a BMI less than 30 kg/m2. Effective October 1, 2023, the codes 33254, 33255, 33256, 33258, 33265 and 33266 were configured as Experimental/Investigational for an open or modified maze procedure performed on a non-beating heart during cardiopulmonary bypass without concomitant cardiac surgery.
Florida Blue · Identified Jun 16, 2026Medium impact
Florida Blue Medicare Risk Adjustment Best Practices and Coding Educational Guide, 2023
For Medicare Advantage risk adjustment under the CMS-HCC models V24 and V28, diagnoses must be supported by clear, specific medical record documentation. Chronic conditions must be reported once a year to maintain the patient's HCC risk score, and key status conditions such as amputation or transplant status must also be reported each year. Documentation rules are set out for chronic conditions including chronic kidney disease, diabetes, heart failure, COPD, cancer, major depression and substance use disorders.

Watch I25.119

Get one email when a payer policy names I25.119, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I25.119?

There are 8 tracked policy changes affecting code I25.119, including updates from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I25.119?

Payers that have issued tracked updates for code I25.119 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna, Blue Cross of Idaho, Florida Blue.

How do I get notified when code I25.119 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I25.119. 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 I25.119?

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

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Computed Tomography to Detect Coronary Artery Calcification

Computed Tomography (CT) for Coronary Calcium Scoring 6.01.13

Intravascular Optical Coherence Tomography (CPB 0829, reviewed 2026-04-27)

Enhanced External Counterpulsation (EECP) (CPB 0262, reviewed 2026-05-14)

Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-02-19)

Coronary Computed Tomography Angiography with Selective Noninvasive Fractional Flow Reserve

One-to-One for Healthcare Professionals - Fall Edition

Florida Blue Medicare Risk Adjustment Best Practices and Coding Educational Guide, 2023

What insurance policy changes affect code I25.119?

Which payers have updated policy for code I25.119?

How do I get notified when code I25.119 policy changes?

Why do payers change policies for code I25.119?