I50.813 Insurance Policy Changes

ICD-10 I50.813 is officially defined as "Acute on chronic right heart failure." code I50.813 is referenced in 6 tracked payer policy changes from UnitedHealthcare, Texas Medicaid, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I50.813 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

UnitedHealthcare · Effective Dec 1, 2026Medium impact
Intravenous Iron Replacement Therapy (Feraheme ® , Injectafer ® , & Monoferric ® )
UnitedHealthcare Community Plan of Indiana revised its Medicaid medical policy for Feraheme (ferumoxytol), Injectafer (ferric carboxymaltose), and Monoferric (ferric derisomaltose). Coverage is now described as proven for iron deficiency anemia without CKD and for iron deficiency anemia with CKD but without ESRD, and Injectafer is covered for iron deficiency in adults with NYHA class II/III heart failure to improve exercise capacity when all listed criteria are met; the policy also adds definitions and ICD-10 codes for these indications and removes the language excluding Indiana.
Texas Medicaid · Effective Oct 1, 2026High impact
Third Quarter 2026 HCPCS Updates for Texas Medicaid
Texas Medicaid's third quarter 2026 HCPCS update made new codes effective for dates of service on or after October 1, 2026, which is already in effect. Several added drug codes will be denied until a rate is implemented and then reprocessed back to October 1, while other added codes are pending a rate hearing, some codes are non-covered, and 18 codes were discontinued after September 30, 2026. Some codes carry prior authorization, age or diagnosis limits, so the billing team needs to update charge entry before claims go out.
Medicare/CMS - Transmittals · Effective Oct 28, 2025Medium impact
R13806NCD: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
Already effective October 28, 2025, CMS covers Cardiac Contractility Modulation (CCM) for the treatment of heart failure under Coverage with Evidence Development (CED), according to the criteria in NCD 20.39. CCM for heart failure is not covered for patients outside of a CMS-approved study. Part A CCM claims must include value code D4 with the 8-digit National Clinical Trial (NCT) number, and Part B CCM line items in a clinical research study must include the clinical trial number.
Medicare/CMS - Transmittals · Effective Oct 28, 2025Medium impact
R13806CP: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
Already effective October 28, 2025, CMS covers Cardiac Contractility Modulation (CCM) for the treatment of heart failure under Coverage with Evidence Development, but CCM for heart failure is not covered for patients outside of a CMS-approved study. Professional claims must be billed with one of the listed CPT or HCPCS codes, one of the listed ICD-10-CM diagnoses, ICD-10 Z00.6 as other diagnosis, place of service 11, 19, 21, 22, 24, 26, 71 or 72, the 8-digit clinical trial identifier number, and modifier Q0. Institutional claims require either TOB 11X with the listed ICD-10-PCS codes and value code D4 with the clinical trial number, or TOB 012X, 013X or 085X with the listed CPT and HCPCS codes, value code D4, and condition code 30 or modifier Q0.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure
Biventricular pacemakers with or without an implantable defibrillator may be considered medically necessary for heart failure in individuals with NYHA class III or IV symptoms, a left ventricular ejection fraction below 35%, sinus rhythm, guideline-directed medical therapy, and either left bundle branch block or a QRS interval of 150 ms or more. The same devices may also be considered medically necessary for NYHA class II heart failure with an ejection fraction of 30% or less and the same rhythm, therapy, and bundle branch block or QRS criteria, and for individuals with NYHA class I to IV heart failure, an ejection fraction of 50% or less, and atrioventricular block requiring a high percentage of ventricular pacing when they have an indication for a ventricular pacemaker, as an alternative to a right ventricular pacemaker. Biventricular pacing is considered investigational for NYHA class I heart failure and for heart failure with atrial fibrillation in individuals who do not meet these criteria, and triple-site cardiac resynchronization therapy, wireless left ventricular endocardial pacing, and an intrathoracic fluid monitoring sensor as a component of a biventricular pacemaker are considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Catheter Ablation as Treatment for Atrial Fibrillation
Transcatheter radiofrequency ablation, cryoablation or pulsed field ablation for atrial fibrillation may be considered medically necessary for symptomatic paroxysmal or symptomatic persistent atrial fibrillation that has failed to respond to adequate trials of antiarrhythmic medications, or as an alternative to atrioventricular nodal ablation and pacemaker insertion in individuals with class II or III congestive heart failure and symptomatic atrial fibrillation. It may also be considered medically necessary as an initial treatment for recurrent symptomatic paroxysmal atrial fibrillation (more than 1 episode, with 4 or fewer episodes in the previous 6 months) when a rhythm-control strategy is desired, and repeat ablation may be considered for recurrence of atrial fibrillation or development of atrial flutter following the initial procedure. Ablation for atrial fibrillation that does not meet these criteria is considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I50.813?

There are 6 tracked policy changes affecting code I50.813, including updates from UnitedHealthcare, Texas Medicaid, Medicare/CMS - Transmittals. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I50.813?

Payers that have issued tracked updates for code I50.813 include: UnitedHealthcare, Texas Medicaid, Medicare/CMS - Transmittals, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code I50.813 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I50.813. 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 I50.813?

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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Intravenous Iron Replacement Therapy (Feraheme ® , Injectafer ® , & Monoferric ® )

Third Quarter 2026 HCPCS Updates for Texas Medicaid

R13806NCD: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

R13806CP: Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure

Catheter Ablation as Treatment for Atrial Fibrillation

What insurance policy changes affect code I50.813?

Which payers have updated policy for code I50.813?

How do I get notified when code I50.813 policy changes?

Why do payers change policies for code I50.813?