What insurance policy changes affect code I27.81?

There are 2 tracked policy changes affecting code I27.81, including updates from 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 I27.81?

Payers that have issued tracked updates for code I27.81 include: Blue Cross & Blue Shield of Mississippi.

How do I get notified when code I27.81 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I27.81. 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 I27.81?

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.

PAYER POLICY CHANGES

I27.81 Insurance Policy Changes

ICD-10 I27.81 is officially defined as "Cor pulmonale (chronic)." code I27.81 is referenced in 2 tracked payer policy changes from 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 I27.81 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Pulmonary Arterial Hypertension
Prior authorization is required for the pulmonary arterial hypertension medications in this policy, and the requested medication may be considered medically necessary when all initial criteria are met. For pulmonary arterial hypertension (WHO Group 1), the criteria include right heart catheterization confirmation with mean pulmonary arterial pressure greater than 20 mmHg, pulmonary capillary wedge pressure less than 15 mmHg, and pulmonary vascular resistance of at least 2 Wood units, along with WHO functional class II or greater. Winrevair (sotatercept-csrk) is considered not medically necessary because its place in therapy has not yet been addressed in clinical practice guidelines, and Opsynvi (macitentan-tadalafil), Tadliq (tadalafil oral suspension), Tyvaso DPI (treprostinil inhalation powder) and Yutrepia (treprostinil inhalation powder) are considered not medically necessary as other formulary options exist.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Oxygen
Oxygen and oxygen accessories are considered durable medical equipment, and coverage is subject to the member's DME benefit. Oxygen therapy is medically necessary for severe lung disease defined by a resting PaO2 below 55 mm Hg (or 60 mm Hg with heart failure), an O2 saturation below 90 percent, or symptoms of oxygen deprivation such as impaired cognitive processes, restlessness or insomnia, and for cluster headaches when other treatment fails. Oxygen therapy is not medically necessary for angina or breathlessness without evidence of hypoxemia, severe peripheral vascular disease with clinically evident desaturation, or terminal illnesses that do not affect the lungs.

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Pulmonary Arterial Hypertension

Oxygen

What insurance policy changes affect code I27.81?

Which payers have updated policy for code I27.81?

How do I get notified when code I27.81 policy changes?

Why do payers change policies for code I27.81?