N62 Insurance Policy Changes

ICD-10 N62 is officially defined as "Hypertrophy of breast." code N62 is referenced in 10 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code N62 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 Mississippi · Effective Oct 1, 2026Medium impact
Risk-Reducing Mastectomy
Risk-reducing mastectomy may be considered medically necessary for individuals at high risk of breast cancer, including those with lobular carcinoma in situ, a known BRCA1 or BRCA2 variant, another high-risk gene variant such as TP53, PTEN, CDH1, STK11 or PALB2, or chest radiotherapy before 30 years of age. It is considered investigational for all other indications, including contralateral risk-reducing mastectomy in individuals with breast cancer who do not meet high-risk criteria. On 10/01/2026 the code reference was updated to add ICD-10 diagnosis codes QA1.790, QA1.791 and QA1.792.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Reduction Mammoplasty
Bilateral reduction mammoplasty in a female is considered medically necessary and not cosmetic when the listed clinical indications and documentation are present, including a minimum amount of breast tissue removed from each breast by patient height, from 300 grams under 5 feet to 400 grams over 5 feet 9 inches. Augmentation is not covered regardless of medical necessity, and liposuction for any condition, including reduction mammoplasty, is considered cosmetic. Mastectomy for gynecomastia in a male over 18 is medically necessary only when the tissue removed is glandular breast tissue and not the result of obesity, adolescence, or reversible drug effects.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Free Testosterone Testing
Serum free testosterone (CPT 84402) is medically necessary to distinguish a sex hormone-binding globulin (SHBG) abnormality from hypogonadism in obese males with symptoms of hypogonadism when total testosterone is low, to diagnose hyperandrogenism in symptomatic females, and in patients with a medical diagnosis that may increase or decrease SHBG levels. It is not medically necessary to diagnose testosterone deficiency in non-obese males with symptoms of hypogonadism, or when performed for screening of asymptomatic patients. Free testosterone should be performed by equilibrium dialysis, and free testosterone measured by an analog method should never be ordered.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Estrogen Hormone Testing: Estradiol and Estrone
Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism, to diagnose hyperestrogenism in symptomatic males, to monitor hormone replacement therapy in postmenopausal females, and to monitor antiestrogen therapy. Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients. The covered tests are total estradiol (CPT 82670), fractionated estrogens (CPT 82671), total estrogens (CPT 82672), estrone (CPT 82679), and free estradiol by direct measurement, such as equilibrium dialysis (CPT 82681).
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA11.110a, Surgery for Gynecomastia
This is a reissue with no substantive changes to MA11.110a. The policy maintains existing coverage criteria for gynecomastia surgery under Independence Blue Cross Medicare Advantage plans, requiring Grade III-IV disease, failed conservative treatment, and documented functional impairment. No billing codes, coverage rules, or documentation requirements have changed since the original 12/19/2022 effective date.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA11.110a, Surgery for Gynecomastia
This is a reissue of MA11.110a with no substantive changes to coverage criteria for gynecomastia surgery. The policy continues to require Grade III or IV severity, 3-4 months of persistence, failed conservative treatment, and documented pain or functional impairment for coverage. Independence Blue Cross Medicare Advantage is reaffirming existing medical necessity standards per their annual review process.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.08.12i, Surgery for Gynecomastia
This is a routine annual reissue of Independence Blue Cross policy 11.08.12i with no substantive changes to coverage criteria, medical necessity requirements, or billing codes. The policy maintains coverage for CPT 19300 (mastectomy for gynecomastia) and CPT 19318 (reduction mammoplasty), while CPT 15877 (suction-assisted lipectomy) remains experimental/investigational.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.08.12i, Surgery for Gynecomastia
This is a routine annual policy reissue with no substantive changes to Independence Blue Cross's gynecomastia surgery coverage. The policy maintains existing medically necessary criteria (Grade II+ gynecomastia, age 18+, 3-month analgesic trial, documented glandular tissue, significant functional impact) and continues to classify liposuction-only treatment as experimental/investigational. CPT 19318 remains the covered code for reduction mammoplasty; CPT 15877 remains non-covered.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code N62?

There are 10 tracked policy changes affecting code N62, including updates from Blue Cross & Blue Shield of Mississippi, Aetna, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code N62?

Payers that have issued tracked updates for code N62 include: Blue Cross & Blue Shield of Mississippi, Aetna, Independence Blue Cross.

How do I get notified when code N62 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code N62. 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 N62?

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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Risk-Reducing Mastectomy

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

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

Reduction Mammoplasty

Free Testosterone Testing

Estrogen Hormone Testing: Estradiol and Estrone

MA11.110a, Surgery for Gynecomastia