J35.01 Insurance Policy Changes

ICD-10 J35.01 is officially defined as "Chronic tonsillitis." code J35.01 is referenced in 3 tracked payer policy changes from Aetna and Blue Cross Blue Shield of Wyoming. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code J35.01 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 17, 2026Medium impact
Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)
Aetna considers FDA-cleared carbon isotope (13C or 14C) urea breath testing and stool antigen testing (HpSA) medically necessary for active Helicobacter pylori infection in selected persons, including adults with idiopathic thrombocytopenic purpura, persons before bariatric surgery, persons before starting proton pump inhibitor therapy for dyspepsia, and persons taking long term, low-dose aspirin or initiating chronic NSAID treatment. Nucleic acid amplification for clarithromycin resistance testing is medically necessary for selecting salvage regimens for treatment-experienced individuals with persistent H. pylori infection. H. pylori serology, the AmHPR panel, IL-1B and TNFA gene polymorphism testing, and urea breath or stool antigen testing for other indications such as stroke risk, dementia risk and screening of asymptomatic persons are considered experimental, investigational or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Coblation (CPB 0475, reviewed 2026-07-02)
Aetna considers coblation tonsillectomy medically necessary for peri-tonsillar abscess, recurrent middle ear infection where tonsillar hypertrophy is believed to be an exacerbating factor, recurrent or chronic tonsillar infection, and tonsillar hypertrophy leading to respiratory symptoms or airway obstruction. Aetna considers many other coblation uses experimental, investigational or unproven because their effectiveness has not been established, including coblation adenoidectomy, coblation nasal septal swell body reduction, coblation with or without gastrocnemius release for plantar fasciitis, coblation devices such as the Topaz Microdebrider for insertional Achilles tendinopathy and lateral epicondylitis, and radiofrequency to the nasal valve (Vivaer Nasal Airway Remodeling) for nasal airway obstruction. The policy lists cervical coblation nucleoplasty, coblation non-thermal volumetric tissue reduction, and several other coblation procedures as CPT codes not covered for the indications listed in the policy.
Blue Cross Blue Shield of Wyoming · Identified Jun 19, 2026Medium impact
HEDIS Codes, UM Tool Updates & Coding Advice
Blue Cross Blue Shield of Wyoming is requesting providers use specific Category II codes (3044F, 3051F, 3052F, 3046F) with HbA1c lab tests (CPT 83036) to improve HEDIS scores for On-exchange and FEP members. The policy also announces upcoming UM tool updates for fall and provides coding advice for automated claims review starting in March.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code J35.01?

There are 3 tracked policy changes affecting code J35.01, including updates from Aetna, Blue Cross Blue Shield of Wyoming. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code J35.01?

Payers that have issued tracked updates for code J35.01 include: Aetna, Blue Cross Blue Shield of Wyoming.

How do I get notified when code J35.01 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code J35.01. 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 J35.01?

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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Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)

Coblation (CPB 0475, reviewed 2026-07-02)

HEDIS Codes, UM Tool Updates & Coding Advice

What insurance policy changes affect code J35.01?

Which payers have updated policy for code J35.01?

How do I get notified when code J35.01 policy changes?

Why do payers change policies for code J35.01?