I42.1 Insurance Policy Changes

ICD-10 I42.1 is officially defined as "Obstructive hypertrophic cardiomyopathy." code I42.1 is referenced in 8 tracked payer policy changes from Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I42.1 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 Oct 1, 2026High impact
05.00.77g, Implantable Cardioverter Defibrillators
Independence Blue Cross updated ICD-10 diagnosis codes effective 10/01/2026 for Policy 05.00.77g (Implantable Cardioverter Defibrillators). Three codes were terminated (I42.0, I42.8, I49.8) and nine new codes were added with greater specificity, including new codes for Brugada syndrome (I49.81), catecholaminergic polymorphic ventricular tachycardia (I47.22), ventricular bigeminy (I49.82), and arrhythmogenic cardiomyopathy (I42.81). The policy itself was not fully reviewed; this is a routine annual ICD-10 code update.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Wearable Cardioverter Defibrillators
Prior authorization and Care Management approval are required for a wearable cardioverter defibrillator (WCD) used for ischemic cardiomyopathy following an acute myocardial infarction and for newly diagnosed nonischemic cardiomyopathy. Effective 2026-10-01, the Code Reference adds ICD-10 codes I42.00, I42.01, I42.09, I42.81, I42.89, I47.22, I49.81, I49.82, and I49.89 and removes ICD-9 diagnosis codes. A WCD is medically necessary as interim treatment for individuals who meet the ICD criteria but have a temporary contraindication to an ICD, such as a systemic infection, and as a bridge to left ventricular improvement or possible ICD implantation in the covered indications.
Independence Blue Cross · Effective Apr 1, 2026Medium impact
05.00.77f, Implantable Cardioverter Defibrillators
Independence Blue Cross updated Medical Policy 05.00.77f to version 05.00.77g, expanding coverage to address transvenous, subcutaneous, and extravascular implantable cardioverter defibrillators (ICDs). The policy reissued on 04/01/2026 communicates the Company's continuing position on ICD coverage. Transvenous and subcutaneous ICDs remain covered when medical necessity criteria are met; extravascular ICDs remain experimental/investigational and not covered.
Independence Blue Cross · Effective Apr 1, 2026Medium impact
05.00.77f, Implantable Cardioverter Defibrillators
Independence Blue Cross updated policy 05.00.77f to 05.00.77g, expanding coverage to include transvenous, subcutaneous, and extravascular implantable cardioverter defibrillators (ICDs). The policy clarifies medical necessity criteria for primary prevention across multiple cardiac conditions and explicitly excludes extravascular ICDs as experimental/investigational. Billing teams must ensure claims are coded correctly and that extravascular ICD claims are denied per policy.
Aetna · Identified Oct 2, 2026Medium impact
Cardiac Catheter Ablation (CPB 0165, reviewed 2026-08-25)
Aetna considers cardiac catheter ablation with electrophysiological studies medically necessary for listed atrial fibrillation, atrioventricular nodal reentrant tachycardia, atrial tachycardia and flutter, accessory pathway, and ventricular arrhythmia indications, each with its own clinical conditions such as symptoms, drug failure or intolerance, or a high-risk accessory pathway. Pulsed field ablation is considered an equally acceptable alternative to standard radiofrequency ablation for medically necessary indications. Ablation for all other indications is considered experimental, investigational, or unproven, and so are alcohol ablation of the vein of Marshall, the AtriCure Isolator Synergy EnCompass Clamp, cardio-neuro-ablation, intra-myocardial infusion-needle catheter ablation for ventricular tachycardia, non-invasive cardiac radio-ablation, and sinus node-sparing hybrid ablation.
Aetna · Identified Sep 30, 2026Medium impact
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-08-21)
Aetna considers alcohol septal ablation (PTSMA) medically necessary for adults 21 years of age and older with hypertrophic obstructive cardiomyopathy when all listed criteria are met, including a clinical diagnosis of hypertrophic cardiomyopathy by echocardiography or cardiovascular MRI, severe symptoms that interfere with activities of daily living despite optimal drug therapy, NYHA functional class III or IV, and a peak LVOT gradient of 50 mm Hg or more. Aetna also considers PTSMA medically necessary for carefully selected members aged 5 to 20 with HOCM who meet separate pediatric criteria, and considers PTSMA for all other indications, SESAME, and ultrasound-guided PTSMA 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
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
Under this BCBS policy, genetic testing for predisposition to hypertrophic cardiomyopathy may be considered medically necessary for individuals who have a first-degree relative with established hypertrophic cardiomyopathy, when a known pathogenic gene variant is present in that affected relative. Testing is considered investigational for individuals whose first-degree relative with established hypertrophic cardiomyopathy tested negative for pathogenic variants, and for all other populations. The policy history records an 08/18/2026 review with the policy statements unchanged and the code reference updated to remove ICD-9 diagnosis codes.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I42.1?

There are 8 tracked policy changes affecting code I42.1, including updates from Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I42.1?

Payers that have issued tracked updates for code I42.1 include: Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code I42.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I42.1. 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 I42.1?

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.

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05.00.77g, Implantable Cardioverter Defibrillators

Wearable Cardioverter Defibrillators

05.00.77f, Implantable Cardioverter Defibrillators

05.00.77f, Implantable Cardioverter Defibrillators

Cardiac Catheter Ablation (CPB 0165, reviewed 2026-08-25)

Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-08-21)

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

Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy

What insurance policy changes affect code I42.1?

Which payers have updated policy for code I42.1?

How do I get notified when code I42.1 policy changes?

Why do payers change policies for code I42.1?