N64.4 Insurance Policy Changes

ICD-10 N64.4 is officially defined as "Mastodynia." code N64.4 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 N64.4 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 14, 2026Medium impact
Breast Implant Removal (CPB 0142, reviewed 2026-03-19)
Aetna considers breast implant removal medically necessary for members who had cosmetic augmentation or breast reconstruction after a medically necessary mastectomy and who meet at least one listed criterion. The criteria include breast cancer in the implanted or contralateral breast where implant removal is necessary to excise the cancer, breast implant-associated anaplastic large cell lymphoma, implant extrusion through the skin, recurrent infections, Baker Class IV contracture associated with severe pain, severe contracture that interferes with mammography, intra- or extra-capsular rupture of silicone gel-filled implants, cutaneous hypersensitivity-like reactions that failed conventional treatments, and persistent pain, lumps, swelling or asymmetry in textured implants after the surgical incision has fully healed. Requests for removal for Baker Class III contracture that does not follow a medically necessary mastectomy, for a biopsy of a breast mass not proven to be cancerous, or for a mastectomy or lumpectomy that can be performed with the implant in place are subject to medical review. Aetna does not consider IgG testing in connection with silicone implants medically necessary, and it does not consider removal of silicone implants for autoimmune disease medically necessary unless a selection criterion is met.
Aetna · Identified Aug 14, 2026Medium impact
Cryoanalgesia and Therapeutic Cold (CPB 0297, reviewed 2026-04-14)
Aetna considers passive cold compression therapy units (such as the Aircast Cryo/Cuff, Polar Care Cub and Polar Care Packs) medically necessary DME to control swelling, edema, hematoma, hemarthrosis and pain, and considers passive hot and cold therapy medically necessary. Cryoanalgesia is considered medically necessary for temporary relief of pain due to chronic refractory trigeminal neuralgia when the selection criteria are met, and for pre-operative, intra-operative and post-operative cryoanalgesia for post-operative pain management related to the Nuss or Ravitch procedure. Active cold units with mechanical pumps, devices that deliver both hot and cold therapy, cryoneurolysis for abdominal pain associated with pancreatic cancer, acute pain, cervicogenic headache, occipital neuralgia, peripheral neuropathic pain, phantom limb pain and post-herpetic neuralgia, pre-operative cryoneurolysis for pain following total knee arthroplasty, prophylactic hypothermia for traumatic brain injury, therapeutic hypothermia for cardiogenic shock or hemorrhagic stroke, intra-brain hypothermia for concussion, submucosal cryolysis, the Cooral intraoral cooling system, and bedside percutaneous cryoneurolysis for acute rib fracture pain are considered experimental, investigational or unproven. Passive cold compression therapy units for all other indications, and intra-operative and post-operative cryoanalgesia for post-thoracotomy pain, post-tonsillectomy pain, post-sternotomy pain and post-mastectomy pain, are also considered experimental, investigational or unproven.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code N64.4?

There are 2 tracked policy changes affecting code N64.4, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code N64.4?

Payers that have issued tracked updates for code N64.4 include: Aetna.

How do I get notified when code N64.4 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code N64.4. 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 N64.4?

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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Breast Implant Removal (CPB 0142, reviewed 2026-03-19)

Cryoanalgesia and Therapeutic Cold (CPB 0297, reviewed 2026-04-14)

What insurance policy changes affect code N64.4?

Which payers have updated policy for code N64.4?

How do I get notified when code N64.4 policy changes?

Why do payers change policies for code N64.4?