What insurance policy changes affect code L98.494?

There are 2 tracked policy changes affecting code L98.494, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code L98.494?

Payers that have issued tracked updates for code L98.494 include: Aetna.

How do I get notified when code L98.494 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code L98.494. 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 L98.494?

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

L98.494 Insurance Policy Changes

ICD-10 L98.494 is officially defined as "Non-pressure chronic ulcer of skin of other sites with necrosis of bone." code L98.494 is referenced in 2 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code L98.494 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

Aetna · Identified Nov 2, 2026Medium impact
Breast Reduction Surgery and Gynecomastia Surgery (CPB 0017, reviewed 2026-10-26)
Aetna's Breast Reduction Surgery and Gynecomastia Surgery policy (CPB 0017) was reviewed on 2026-10-26, and the source does not state what changed or give a new effective date. It sets the criteria for breast reduction (CPT 19318) to be covered for symptomatic macromastia, including documented symptoms, a 3-month trial of conservative care, a resection weight that meets the Schnur body surface area table or more than 1 kg per breast, and a negative mammogram for women 50 or older, and it treats gynecomastia surgery and liposuction-only reduction as cosmetic or experimental.
Aetna · Identified Aug 14, 2026Medium impact
Breast Reduction Surgery and Gynecomastia Surgery (CPB 0017, reviewed 2026-03-12)
Aetna considers reduction mammaplasty (CPT 19318) medically necessary for non-cosmetic indications in women age 18 or older, or once growth is complete with breast size stable for one year. For macromastia, the criteria require persistent symptoms in at least two listed body areas that are attributed to macromastia and affect daily activities for at least 1 year, documented severe breast hypertrophy in high-quality photographs, and symptoms that persist despite at least a 3-month trial of listed therapeutic measures. Gigantomastia of pregnancy is medically necessary when a listed complication is present and delivery is not imminent. Breast reduction, surgical mastectomy, or liposuction for gynecomastia is considered cosmetic, and several listed techniques are considered experimental, investigational, or unproven.

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Breast Reduction Surgery and Gynecomastia Surgery (CPB 0017, reviewed 2026-10-26)

Breast Reduction Surgery and Gynecomastia Surgery (CPB 0017, reviewed 2026-03-12)

What insurance policy changes affect code L98.494?

Which payers have updated policy for code L98.494?

How do I get notified when code L98.494 policy changes?

Why do payers change policies for code L98.494?