I35.0 Insurance Policy Changes

ICD-10 I35.0 is officially defined as "Nonrheumatic aortic (valve) stenosis." code I35.0 is referenced in 14 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 I35.0 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Independence Blue Cross has reissued MA11.027g (now superseded by MA11.027h) to communicate updated coverage criteria for transcatheter cardiac valve procedures, specifically adding CPT codes 0569T and 0570T for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 Oct 29, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)
Aetna considers transcatheter aortic valve implantation (TAVI) medically necessary when criteria are met. Those criteria cover severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and an ejection fraction greater than 20%, and valve-in-valve replacement of a degenerated bioprosthetic aortic valve in patients with a Society of Thoracic Surgeons operative risk score of 8% or greater or a judged 15% or greater risk of mortality from surgical replacement. Percutaneous repair of prosthetic paravalvular leak is also considered medically necessary under specific conditions, while BASILICA, combined TAVI and left atrial appendage occlusion, embolic protection devices, TAVI for ongoing sepsis or endocarditis, and several prognostic tests are listed as experimental, investigational or unproven.
Aetna · Identified Oct 7, 2026Medium impact
Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)
Aetna considers measurement of plasma brain natriuretic peptide (BNP) medically necessary to differentiate dyspnea due to heart failure from pulmonary disease, to determine prognosis or severity in chronic heart failure, to screen for heart failure annually in adults with diabetes mellitus, to measure upon hospital admission and before discharge in acutely decompensated heart failure, for preoperative cardiac risk assessment before elevated-risk noncardiac surgery in members with known cardiovascular disease, age 65 or older, or age 45 or older with cardiovascular symptoms, and as an adjunct test for risk stratification of Stage C aortic stenosis. Serial BNP and NT-proBNP measurements and the other uses listed in the policy, such as diagnosing Kawasaki disease, are considered experimental, investigational, or unproven. CPT 83880 is covered when the selection criteria are met, except as a cardiovascular biomarker in healthy normal subjects and for identifying stress-induced myocardial ischemia.
Aetna · Identified Oct 1, 2026Medium impact
Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (CPB 0610, reviewed 2026-09-18)
Aetna considers FDA-approved biventricular pacemakers (cardiac resynchronization therapy) medically necessary for members with congestive heart failure who are in sinus rhythm when either of two criteria sets is met. The first set requires NYHA class III or IV heart failure, LVEF of 35% or less, QRS duration of 150 msec or more, and an optimal pharmacologic regimen defined as 3 months of maximally titrated doses as tolerated before implantation, or being at least 40 days post myocardial infarction. The second set requires NYHA class II to IV, LVEF of 35% or less, left bundle branch block with QRS duration of 130 msec or more, and the same optimal pharmacologic regimen, or being at least 40 days post MI. Combination resynchronization-defibrillator devices are medically necessary for members at high risk for sudden cardiac death when those criteria are met and one of the listed conditions applies, and left bundle branch pacing is medically necessary when cardiac resynchronization therapy is indicated and left ventricular pacing cannot be accomplished.
Aetna · Identified Aug 19, 2026Medium impact
Zoledronic Acid (CPB 0524, reviewed 2026-02-12)
Aetna's clinical policy bulletin covers zoledronic acid for commercial medical plans. Zoledronic acid 5 mg (Reclast or generic) is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget's disease of bone, and treatment-related bone loss in men with prostate cancer receiving androgen deprivation therapy, when the listed criteria are met. Zoledronic acid 4 mg (formerly branded Zometa) is considered medically necessary for bone metastases from a solid tumor, certain breast cancer indications, hypercalcemia of malignancy, Langerhans cell histiocytosis with bone disease, multiple myeloma, and systemic mastocytosis with osteopenia or osteoporosis. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)
Aetna Clinical Policy Bulletin 0826 covers transcatheter aortic valve implantation (TAVI). Aetna considers TAVI with an FDA-approved valve medically necessary for severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and with an ejection fraction greater than 20%, and for valve-in-valve replacement of a degenerated bioprosthetic aortic valve when the STS operative risk score is 8% or greater or the member is judged to be at 15% or greater risk of mortality for surgical aortic valve replacement. Percutaneous repair of prosthetic paravalvular leak is medically necessary when intractable hemolysis or NYHA class III or IV symptoms, high or prohibitive surgical risk, suitable anatomy and a comprehensive valve center are all met, and BASILICA, combined TAVI and left atrial appendage occlusion, pre-implantation balloon aortic valvuloplasty, embolic protection devices, and TAVI for sepsis, bicuspid aortic stenosis, native aortic valve regurgitation or porcelain aorta are listed as experimental, investigational or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Selected Aortic Valve Procedures (CPB 0407, reviewed 2026-07-07)
Aetna considers the Ross pulmonary autograft procedure medically necessary for aortic valve replacement caused by congenital anomalies or aortic valve disease, and considers aortic valve-sparing re-implantation medically necessary for secondary aortic regurgitation from aortic root dilatation, such as in Marfan syndrome, and for type A acute aortic dissections. The Ross procedure and aortic valve-sparing re-implantation are considered experimental, investigational, or unproven for all other indications, and so are the Florida Sleeve valve-sparing procedure, Personalized External Aortic Root Support (PEARS), and the Matrix P bioprosthesis for pulmonary valve replacement in Ross procedures. the policy was last reviewed 07/07/2026.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (CPB 0610, reviewed 2025-12-02)
Aetna considers FDA-approved biventricular pacemakers (cardiac resynchronization therapy) medically necessary for members with congestive heart failure who are in sinus rhythm when either NYHA class III or IV with LVEF less than or equal to 35%, QRS duration greater than or equal to 150 msec, and an optimal pharmacologic regimen of 3 months of maximally titrated doses as tolerated before implantation are met, or at least 40 days post myocardial infarction; or when NYHA class II to IV with LVEF less than or equal to 35%, left bundle branch block with QRS duration greater than or equal to 130 msec, and the same regimen or at least 40 days post MI are met. Aetna considers combination resynchronization-defibrillator devices medically necessary for members at high risk for sudden cardiac death when those criteria are met and at least one of the following applies: at least 1 episode of cardiac arrest from ventricular tachyarrhythmias, recurring poorly tolerated sustained ventricular tachycardia, a prior heart attack with documented non-sustained ventricular tachycardia and an inducible ventricular tachyarrhythmia, or a prior heart attack with LVEF less than or equal to 30%. Aetna considers left bundle branch pacing medically necessary when cardiac resynchronization therapy is indicated and left ventricular pacing cannot be accomplished, and considers biventricular pacing for atrial fibrillation, mild heart failure (NYHA class I), and anti-bradycardia pacing, wireless left ventricular endocardial pacing, His bundle pacing for cardiac resynchronization therapy, the galectin-3 test, and implantable diaphragmatic stimulation (VisCardia's VisONE system) experimental, investigational, or unproven.
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
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 I35.0?

There are 14 tracked policy changes affecting code I35.0, 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 I35.0?

Payers that have issued tracked updates for code I35.0 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code I35.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I35.0. 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 I35.0?

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

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)

Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)

Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (CPB 0610, reviewed 2026-09-18)

Zoledronic Acid (CPB 0524, reviewed 2026-02-12)

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)

Selected Aortic Valve Procedures (CPB 0407, reviewed 2026-07-07)

Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (CPB 0610, reviewed 2025-12-02)

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

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 I35.0?

Which payers have updated policy for code I35.0?

How do I get notified when code I35.0 policy changes?

Why do payers change policies for code I35.0?