ICD-10 L97.929 is officially defined as "Non-pressure chronic ulcer of unspecified part of left lower leg with unspecified severity." code L97.929 is referenced in 8 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, Aetna, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code L97.929 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Blue Cross Blue Shield of North Dakota updated multiple medical policies with new covered services, revised criteria, coding changes, and consent policies effective February 19, 2026. Key changes include new procedure codes for prostate treatments, bone density studies, and various other specialties, plus removal of experimental procedure codes.
Aetna considers electrical stimulation medically necessary durable medical equipment for arterial ulcers, diabetic ulcers, Stage III or IV pressure ulcers, and venous stasis ulcers when it is used as adjunctive therapy after no measurable signs of healing for at least 30 days of conventional wound treatment. Courses exceeding 1 hour per day are not considered medically necessary, continued stimulation is not medically necessary if measurable healing is not shown within a 4-week treatment period or once the wound bed is 100% epithelialized, and electrical stimulation for chronic ulcers in the home setting is considered not medically appropriate. Aetna considers electrical stimulation experimental, investigational, or unproven for uses including prevention of ulcers and pressure sores, infected wounds, microcurrent as an adjunctive therapy, and the VeinoPlus device for venous ulcers.
Aetna considers epoprostenol (Flolan, Veletri, or generic epoprostenol injection), iloprost inhalation (Ventavis), treprostinil inhalation (Tyvaso), and treprostinil injection (Remodulin or generic treprostinil injection) medically necessary for pulmonary arterial hypertension (PAH) when the initial approval criteria are met, and for pulmonary hypertension associated with interstitial lung disease (PH-ILD) for Tyvaso only. Aetna considers sotatercept-csrk (Winrevair) medically necessary for PAH in members 18 years of age and older when PAH is confirmed by right heart catheterization and the drug is used as add-on therapy alongside medications from at least two of the listed PAH drug classes. Continuation of these therapies is considered medically necessary for members who receive them through a previously authorized pharmacy or medical benefit and who show disease stability or disease improvement.
Aetna's commercial policy sets the criteria for epoprostenol (Flolan, Veletri), iloprost inhalation (Ventavis), treprostinil inhalation (Tyvaso) and treprostinil injection (Remodulin) for pulmonary arterial hypertension (PAH, WHO Group 1), with Tyvaso also covered for pulmonary hypertension associated with interstitial lung disease (PH-ILD, WHO Group 3) when criteria are met. Sotatercept-csrk (Winrevair) is covered for members 18 years of age and older with PAH when they meet its add-on criteria, and atrial septostomy and balloon pulmonary angioplasty are covered for refractory severe PAH with right heart failure. Aetna considers pulmonary artery hypertension drugs experimental for pulmonary hypertension secondary to asthma, chronic obstructive pulmonary disease, congestive heart failure, ischemic vascular disease or lung resection.
Blue Cross Blue Shield Association policy 7.01.124 (BCBSMS policy A.7.01.124) states that treatment of great or small saphenous veins, accessory saphenous veins, varicose tributaries, and perforator veins may be considered medically necessary for symptomatic varicose veins or venous insufficiency when specific criteria are met, and that saphenous vein treatment not meeting those criteria is considered cosmetic and investigational. The policy history shows an update dated 09/22/2026 that changed the policy description, made minor changes to the statements for great or small saphenous veins, accessory saphenous veins, and perforator veins, and re-worded the concurrent treatment statements for accessory saphenous veins and symptomatic varicose tributaries for clarity. Telangiectasia treatment is considered cosmetic and investigational.
Healthfirst's October 2026 tip sheet on diabetes mellitus documentation and ICD-10-CM coding explains how to document and code diabetes, including linking complications with the 'diabetic' descriptor, documenting insulin use with its regimen in the final assessment, and avoiding terms such as 'history of' for a current condition. It is educational only, and Healthfirst states that it does not guarantee coverage or payment, which depend on the member's evidence of coverage and the provider's participation agreement.
Aetna's bio-surgery policy (CPB 0556, reviewed September 1, 2026) sets when medicinal leech therapy and medical maggots (bagged larval therapy) are covered, mainly for specific chronic wounds, flap and replant salvage. It lists many other uses, including knee and thumb osteoarthritis, low back pain and burns, as experimental, and the source gives a review date but no effective date.
This is Aetna Clinical Policy Bulletin 0649, reviewed October 2, 2025 and first found by PolicyChanges in August 2026, so it is historical material and the current version should be confirmed before acting. Aetna covers extracorporeal shock-wave therapy only for calcific tendinopathy of the shoulder with a calcium deposit of at least 1 cm lasting 6 months or more after conservative care has failed, and lists dozens of other musculoskeletal, wound and medical uses as experimental, investigational or unproven.
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