What insurance policy changes affect code K92.0?

There are 3 tracked policy changes affecting code K92.0, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code K92.0?

Payers that have issued tracked updates for code K92.0 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code K92.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code K92.0. 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 K92.0?

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.

PAYER POLICY CHANGES

K92.0 Insurance Policy Changes

ICD-10 K92.0 is officially defined as "Hematemesis." code K92.0 is referenced in 3 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code K92.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 18, 2026Medium impact
Transjugular Intrahepatic Portosystemic Shunt (TIPSS) (CPB 0259, reviewed 2026-04-14)
Aetna considers transjugular intrahepatic portosystemic shunt (TIPSS) medically necessary for bleeding gastric, esophageal or ectopic varices, moderate Budd-Chiari syndrome that has failed to respond to anticoagulation, portal hypertensive gastropathy with recurrent bleeding despite beta-blockers, severe refractory ascites in people who are intolerant of repeated large volume paracentesis, and refractory hepatic hydrothorax, when the member meets the selection criteria in the Appendix. TIPSS is experimental, investigational, or unproven for all other indications, including initial therapy for acute variceal hemorrhage, prophylaxis of variceal hemorrhage, and hepatorenal syndrome.
Aetna · Identified Aug 14, 2026Medium impact
Double Balloon Enteroscopy (CPB 0737, reviewed 2025-11-13)
Aetna considers double balloon enteroscopy medically necessary for dilation of small bowel strictures in Crohn's disease, evaluating suspected small bowel malignancies, evaluating the colon after incomplete colonoscopy, suspected Meckel's diverticulum with an indefinite imaging work-up, obscure GI bleeding with objective evidence of recurrent bleeding, removing entrapped foreign bodies in the small bowel, removing large polyps greater than 10 mm in Peutz-Jeghers syndrome, GI bleeding when the small intestine is the source, and use with ERCP in individuals with surgically altered upper GI anatomy. Aetna considers double balloon enteroscopy experimental, investigational or unproven for other indications, including detection of small bowel neuroendocrine tumors, small bowel varices, treatment of intussusception, treatment of angioectasia (type 1 small bowel vascular lesions), and treatment of post-operative bile leakage after hepaticojejunostomy. Combined double balloon enteroscopy and endoscopic ultrasound for evaluation of Crohn's disease is also considered experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Wireless Capsule Endoscopy for Gastrointestinal (GI) Disorders
Wireless capsule endoscopy of the small bowel is medically necessary for suspected small bowel bleeding after prior inconclusive upper and lower GI endoscopic studies performed during the current episode of illness, for initial diagnosis of suspected Crohn disease without evidence of disease on small bowel follow-through and upper and lower endoscopy, for an established Crohn disease diagnosis when there are unexpected changes in disease course or response to treatment, and for small bowel surveillance in hereditary GI polyposis syndromes including familial adenomatous polyposis and Peutz-Jeghers syndrome. Other uses are investigational, including evaluating the extent of known Crohn disease or ulcerative colitis, the esophagus, the colon including colonic polyps or colon cancer, other GI diseases not presenting with GI bleeding, initial evaluation of acute upper GI bleeding, lower GI bleeding with major risks for colonoscopy, and patients following an incomplete colonoscopy. The patency capsule is investigational, and magnetic capsule endoscopy is investigational for unexplained upper abdominal complaints and all other indications.

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Transjugular Intrahepatic Portosystemic Shunt (TIPSS) (CPB 0259, reviewed 2026-04-14)

Double Balloon Enteroscopy (CPB 0737, reviewed 2025-11-13)

Wireless Capsule Endoscopy for Gastrointestinal (GI) Disorders

What insurance policy changes affect code K92.0?

Which payers have updated policy for code K92.0?

How do I get notified when code K92.0 policy changes?

Why do payers change policies for code K92.0?