N60.81 Insurance Policy Changes

ICD-10 N60.81 is officially defined as "Other benign mammary dysplasias of right breast." code N60.81 is referenced in 3 tracked payer policy changes from Capital Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code N60.81 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Capital Blue Cross · Effective Mar 1, 2026High impact
AB2026-01-001 Updates and new information
Effective March 1, 2026, a number of codes newly require preauthorization for Commercial and Medicare Advantage members, including 20985, 22100 and 27860, and HCPCS code H0032 will be denied because the service is not provided directly to members. Codes C1605, C1721 and others no longer require preauthorization effective February 1, 2026, Evolent updated its CT, MRI, PET and cardiac imaging policies effective March 1, 2026, and TurningPoint accepts listed substitute codes for a limited group of musculoskeletal surgical procedures effective February 1, 2026. Effective for claims processed on or after March 1, 2026, facility claims with modifiers 59, XE, XP, XS and XU that do not meet the CMS criteria to bypass an NCCI procedure-to-procedure edit will be rejected, and physical medicine code 97140 is not separately reimbursed when billed with chiropractic manipulative treatment in the same anatomical region.
Aetna · Identified Aug 19, 2026Medium impact
Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)
Aetna considers breast MRI medically necessary for members who had a recent (within the past year) conventional mammogram and/or breast sonogram, when MRI may affect clinical management. Covered circumstances include detecting local tumor recurrence after mastectomy and breast reconstruction with an implant, assessing residual cancer after an incomplete lumpectomy, and adjunct screening to mammography for women at high genetic risk or with a lifetime breast cancer risk of 20 to 25 percent or more. Breast MRI is considered experimental, investigational or unproven for listed uses such as screening women with average breast cancer risk, evaluating BI-RADS 4 or 5 lesions found on mammogram or ultrasound, and screening women with dense breasts who are asymptomatic and have no additional risk factors. Computer-aided detection is considered integral to breast MRI and is not separately reimbursed.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Removal of Benign Skin Lesions and Scars
Cosmetic surgery and any complications of cosmetic surgery are not eligible for coverage, including any operative procedure or portion of one intended solely to improve physical appearance. Removal of seborrheic keratoses, sebaceous (epidermoid) cysts, nevi, papillomas and viral warts (excluding condyloma acuminatum) is medically necessary only when the lesion is symptomatic or has objective signs or symptoms listed in the policy, such as itching, burning, irritation, significant change in color or size or bleeding, physical evidence of inflammation, obstruction of an orifice or clinically restricted vision, clinical uncertainty about malignancy, a prior biopsy indicative of malignancy, or recurrent physical trauma that is documented to have occurred. Removal for reasons such as emotional distress, "makeup trapping" or location alone is considered cosmetic and not medically necessary.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code N60.81?

There are 3 tracked policy changes affecting code N60.81, including updates from Capital Blue Cross, 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 N60.81?

Payers that have issued tracked updates for code N60.81 include: Capital Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code N60.81 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code N60.81. 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 N60.81?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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AB2026-01-001 Updates and new information

Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)

Removal of Benign Skin Lesions and Scars

What insurance policy changes affect code N60.81?

Which payers have updated policy for code N60.81?

How do I get notified when code N60.81 policy changes?

Why do payers change policies for code N60.81?