J9622 Insurance Policy Changes

ICD-10 J9622 is officially defined as "Acute and chronic respiratory failure with hypercapnia." HCPCS J9622 is referenced in 4 tracked payer policy changes from Premera Blue Cross. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9622 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Premera Blue Cross · Effective Jan 2, 2026High impact
Medical Policy and Coding Updates - October 2025
Premera HMO plans in Washington have changes from the October 2025 medical policy and coding update. Dated items include the Abdominal Wall Hernia policy and its codes effective January 2, 2026, advanced imaging site-of-care review through Carelon and a Washington mandate for medical clearance of minors' hearing aid coverage effective January 1, 2026, and Federal Employee Program prior authorization for hip, knee and spine surgery effective January 1, 2026. Several biologic and drug policies also moved products between preferred and non-preferred status.
Premera Blue Cross · Effective Jan 1, 2026High impact
Medical Policy and Coding Updates - September 2025
Premera HMO plans in Washington have changes from the September 2025 medical policy and coding update. The lead item is advanced imaging site-of-care review through Carelon Medical Benefits Management, Inc., effective January 1, 2026 for dates of service on and after that date. Many coded services also now require review for medical necessity and prior authorization, including negative pressure wound therapy, oncology drugs, percutaneous coronary intervention and selected ASC surgical procedures.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - July 2025
Effective October 3, 2025, codes for several drugs, including J0491, J0517, J0638, J2182, J2351, J2356, J2357, J3032, J3111, J3241, J9024, J9272, J9332 and J9334, now require review for site of service, in addition to the existing medical necessity and prior authorization review. Physical and occupational therapy services for individual plans require prior authorization starting with the seventh visit, effective July 3, 2025. Effective September 5, 2025, non-individual plans use InterQual criteria to determine the appropriate level of care for all planned procedures.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - August 2025
Effective January 1, 2026, site of service is reviewed for advanced imaging services under Carelon Medical Benefits Management's Site of Care for Advanced Imaging criteria, and hospital outpatient site of care is considered medically necessary when ancillary services are required and not available at freestanding centers in the same geographic area. Effective November 7, 2025, bariatric surgery reoperation for inadequate weight loss is considered medically necessary if the original procedure fails, such as unsuccessful band adjustments, resulting in less than 50% excess weight loss or less than 20% total weight loss. Effective November 7, 2025, select surgical procedures previously reviewed for site of service in the inpatient setting are reviewed for site of service in the ambulatory surgical center setting under policy 11.01.525.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect HCPCS J9622?

There are 4 tracked policy changes affecting HCPCS J9622, including updates from Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J9622?

Payers that have issued tracked updates for HCPCS J9622 include: Premera Blue Cross.

How do I get notified when HCPCS J9622 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J9622. 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 HCPCS J9622?

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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Medical Policy and Coding Updates - October 2025

Medical Policy and Coding Updates - September 2025

Medical Policy and Coding Updates - July 2025

Medical Policy and Coding Updates - August 2025

What insurance policy changes affect HCPCS J9622?

Which payers have updated policy for HCPCS J9622?

How do I get notified when HCPCS J9622 policy changes?

Why do payers change policies for HCPCS J9622?