Home
Billing codes
K1030

PAYER POLICY CHANGES

K1030 Insurance Policy Changes

HCPCS K1030 is officially defined as "External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only." HCPCS K1030 is referenced in 9 tracked payer policy changes from Medicare/CMS - Transmittals, Medicare/CMS, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS K1030 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medicare/CMS - Transmittals · Effective Jul 1, 2026High impact
R13844CP: July 2026 Integrated Outpatient Code Editor (I/OCE) Specifications Version 27.2
The July 2026 Integrated Outpatient Code Editor (I/OCE) Specifications Version 27.2 take effect July 1, 2026, with implementation on July 6, 2026. Unless otherwise specified, the effective date is the date of service. Edit 139 returns a claim to the provider at the line level when a HCPCS code is reported with modifier 93 or 95 and is not on the CMS Telehealth list. Edit 140 returns a claim to the provider at the line level when a non-BLA skin substitute product is reported with modifier JW or JZ. Modifier AC is added, and many HCPCS codes, APC assignments and status indicators change, including the deletion of HCPCS codes 0029U, 0031U, 0423U, 0577U and C9309 effective July 1, 2026.
Medicare/CMS · Effective May 11, 2026High impact
2026-04-16 - CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System
CMS launched new digital health tools and requires providers to enroll third-party vendors for Medicare eligibility checking by May 11. Multiple billing updates include new ASC payment codes, hospital billing processes, and therapeutic shoe documentation requirements.
Regence BlueShield · Effective Oct 1, 2026Medium impact
New and Emerging Medical Technologies and Procedures
New and emerging medical technologies and procedures named in the listed codes are considered investigational because the current scientific evidence is not yet sufficient to establish their impact on health outcomes. Contracts exclude investigational and cosmetic services or procedures from coverage. Providers may bill members for investigational or cosmetic services and are encouraged to tell members before rendering them that the members are likely to be financially responsible for the cost.
Regence BlueShield · Effective Oct 1, 2026Medium impact
New and Emerging Medical Technologies and Procedures
New and emerging medical technologies and procedures listed in this policy are considered investigational because current scientific evidence is not yet sufficient to establish their impact on health outcomes. The listed services include many CPT codes across imaging, implant, cardiac device, bone assessment, neurostimulation, and oncology algorithm analysis, several tied to named manufacturers. Contracts exclude from coverage services or procedures that are considered investigational, and providers may bill members for them.
Independence Blue Cross · Effective Oct 28, 2025Medium impact
MA05.038, Cardiac Contractility Modulation
Independence Blue Cross Medicare Advantage has issued/reissued policy MA05.038 establishing coverage for Cardiac Contractility Modulation (CCM) therapy for heart failure under a Coverage with Evidence Development (CED) framework. The policy adds 13 new CPT codes, 2 HCPCS codes, and 1 ICD-10 code, and requires CCM claims for CED trial participants to include Modifier Q0 and be submitted to the MA plan. This represents a shift from investigational/non-covered status to conditional coverage for eligible heart failure patients enrolled in CMS-approved clinical trials.
Independence Blue Cross · Effective Oct 28, 2025Medium impact
MA05.038, Cardiac Contractility Modulation
Independence Blue Cross Medicare Advantage has issued a new medical policy (MA05.038) establishing coverage for Cardiac Contractility Modulation (CCM) therapy for heart failure under a Coverage with Evidence Development (CED) framework, effective retroactively to October 28, 2025. The policy adds 13 new CPT codes, 2 HCPCS codes, and 1 ICD-10 code for CCM procedures and devices, requiring strict documentation of optimized medical therapy and exclusion criteria.
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.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Contractility Modulation (CCM) Therapy (CPB 0930, reviewed 2026-03-03)
Aetna considers cardiac contractility modulation (CCM) therapy experimental, investigational, or unproven when it is administered by Impulse Dynamics' Optimizer system or the OPTIMIZER Integra CCM-D System, because its effectiveness has not been established. The listed CPT and HCPCS codes are not covered for the indications in this policy.

Watch K1030

Get one email when a payer policy names K1030, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

REFERENCE DATA

Payers with rules5

Payers requiring prior auth5

Anthem BCBS · Effective October 19, 2026
Prior authorization required
Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial)
CountyCare Health Plan · Effective April 23, 2026
Prior authorization required
CountyCare Prior Authorization Look-Up Tool (All Codes)
Florida Blue · Effective March 27, 2026
Prior authorization required
Prior Authorization List: HMO – Marketplace Qualified Health Plans

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for K1030?

Anthem BCBS lists K1030 on Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial) for commercial plans (list dated October 19, 2026). Verify with the payer before scheduling.

Does Carolina Complete Health require prior authorization for K1030?

Carolina Complete Health lists K1030 on Carolina Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for K1030?

Centene lists K1030 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CountyCare Health Plan require prior authorization for K1030?

CountyCare Health Plan lists K1030 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

Does Florida Blue require prior authorization for K1030?

Florida Blue lists K1030 on Prior Authorization List: HMO – Marketplace Qualified Health Plans for exchange plans (list dated March 27, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS K1030?

There are 9 tracked policy changes affecting HCPCS K1030, including updates from Medicare/CMS - Transmittals, Medicare/CMS, Regence BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS K1030?

Payers that have issued tracked updates for HCPCS K1030 include: Medicare/CMS - Transmittals, Medicare/CMS, Regence BlueShield, Independence Blue Cross, Aetna.

How do I get notified when HCPCS K1030 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS K1030. 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 K1030?

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.

See every payer rule for K1030

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for K1030 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

R13844CP: July 2026 Integrated Outpatient Code Editor (I/OCE) Specifications Version 27.2

2026-04-16 - CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System

New and Emerging Medical Technologies and Procedures

New and Emerging Medical Technologies and Procedures

MA05.038, Cardiac Contractility Modulation

MA05.038, Cardiac Contractility Modulation

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

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

Cardiac Contractility Modulation (CCM) Therapy (CPB 0930, reviewed 2026-03-03)

Prior authorization required

Prior authorization required

Prior authorization required

Does Anthem BCBS require prior authorization for K1030?

Does Carolina Complete Health require prior authorization for K1030?

Does Centene require prior authorization for K1030?

Does CountyCare Health Plan require prior authorization for K1030?

Does Florida Blue require prior authorization for K1030?

What insurance policy changes affect HCPCS K1030?

Which payers have updated policy for HCPCS K1030?

How do I get notified when HCPCS K1030 policy changes?

Why do payers change policies for HCPCS K1030?