What insurance policy changes affect code N13.70?

There are 2 tracked policy changes affecting code N13.70, 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 N13.70?

Payers that have issued tracked updates for code N13.70 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code N13.70 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code N13.70. 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 N13.70?

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

N13.70 Insurance Policy Changes

ICD-10 N13.70 is officially defined as "Vesicoureteral-reflux, unspecified." code N13.70 is referenced in 2 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 N13.70 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 Aug 18, 2026Medium impact
Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents (CPB 0534, reviewed 2026-07-30)
This Aetna clinical policy bulletin covers endoscopic injection of bulking agents for vesicoureteral reflux (VUR). Aetna considers injection of Deflux (dextranomer/hyaluronic acid copolymer), Macroplastique (polydimethylsiloxane), Teflon (polytetrafluoroethylene), or other FDA-approved bulking agents medically necessary for members with primary or secondary VUR who have one of the listed conditions after conservative treatment, such as prophylactic antibiotics and clean intermittent catheterization, has failed. The listed conditions are: a previously unsuccessful ureteral re-implantation; stopping medication because of drug intolerance or parental non-compliance; reflux associated with a thick-walled neuropathic bladder; deterioration of renal parameters regardless of reflux severity; lower grades of reflux (grades I to III); persistent reflux in post-pubertal female members; recurrent, poorly controlled febrile urinary tract infections; or symptomatic VUR after renal transplantation. Aetna considers these injections experimental and investigational for members who do not meet these criteria. Aetna also considers injection of autologous blood, calcium hydroxyapatite, chondrocytes, Durasphere, fat, glutaraldehyde cross-linked bovine dermal collagen, myoblasts, polyacrylamide hydrogel (Bulkamid), and polyacrylate-polyalcohol copolymer (Vantris) experimental, investigational, or unproven for VUR. Members whose condition does not improve after 3 treatment sessions are considered treatment failures, and further treatments are not considered medically necessary.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux
Periureteral bulking agents may be considered medically necessary as a treatment of vesicoureteral reflux grades II, III, or IV when medical therapy has failed and surgical intervention is otherwise indicated. The use of bulking agents as a treatment of vesicoureteral reflux in other clinical situations is considered investigational. Bulking agents are contraindicated in individuals with nonfunctioning kidney(s), Hutch diverticuli, active voiding dysfunction, and ongoing urinary tract infection.

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Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents (CPB 0534, reviewed 2026-07-30)

Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux

What insurance policy changes affect code N13.70?

Which payers have updated policy for code N13.70?

How do I get notified when code N13.70 policy changes?

Why do payers change policies for code N13.70?