N92.1 Insurance Policy Changes

ICD-10 N92.1 is officially defined as "Excessive and frequent menstruation with irregular cycle." code N92.1 is referenced in 8 tracked payer policy changes from Regence BlueShield, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code N92.1 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Regence BlueShield · Effective Nov 1, 2026Medium impact
Surgical Site of Care- Hospital Outpatient
Effective November 1, 2026, site of care medical necessity reviews apply to the listed surgical procedures only when they are performed in an outpatient hospital setting. Use of a hospital outpatient department instead of an ambulatory surgery center or physician office may be considered medically necessary when one or more listed criteria are met, such as no geographically accessible in-network ASC that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring or treatment, ASA Physical Status III or higher, or a BMI over 40. Hospital outpatient use is considered not medically necessary when the criteria are not met.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Endometrial Ablation 4.01.01
The 02/19/26 annual review of Excellus policy 4.01.01 Endometrial Ablation replaced the policy statement on using endometrial ablation for gender dysphoria with a reference to Corporate Medical Policy 3.01.22 Gender Affirming Behavioral Health and Medical Services. The policy considers endometrial ablation medically appropriate only when all listed criteria are met, including menorrhagia for more than three menstrual cycles, failure of or a contraindication to hormone therapy over three consecutive cycles, symptoms that interfere with activities of daily living or anemia unresponsive to treatment, a normal Pap smear within the past 12 months, a normal endometrium within the last six to 12 months, no pregnancy or desire for future pregnancy, and FDA approval of the device. Listed contraindications include known or suspected endometrial carcinoma, an enlarged uterus greater than 10 cm in length, submucosal myomas, active genital or urinary tract infection, and an intrauterine device in place.
Aetna · Identified Aug 14, 2026Medium impact
Endometrial Cancer Screening, Diagnosis, and Prognosis (CPB 0769, reviewed 2025-10-03)
Aetna considers endometrial biopsy medically necessary for the diagnostic evaluation of abnormal uterine bleeding in women suspected of having endometrial hyperplasia or endometrial carcinoma, and for endometrial cancer surveillance in women with Lynch syndrome. The endometrial brush (Tao brush) is an acceptable alternative to a suction curette such as the Pipelle for medically necessary sampling. Sentinel lymph node mapping is medically necessary for pathologic evaluation and surgical staging in persons with endometrial cancer and endometrial intraepithelial neoplasia (EIN), while endometrial biopsy for screening and many biomarker and genetic tests for endometrial cancer are experimental, investigational, or unproven.
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 · Effective Jun 24, 2026Low impact
MA11.065d, Endometrial Ablation
Independence Blue Cross reissued MA11.065d on 06/24/2026 to communicate the Company's continuing position on endometrial ablation coverage for Medicare Advantage members. The policy maintains existing medical necessity criteria, absolute contraindications, and FDA-approved device requirements with no substantive changes to coverage or billing guidance.
Independence Blue Cross · Identified Jun 25, 2026Low impact
MA11.065d, Endometrial Ablation
Independence Blue Cross reissued MA11.065d on 06/24/2026 to communicate the Company's continuing position on endometrial ablation coverage for Medicare Advantage members. The policy maintains existing coverage criteria, absolute contraindications, and medical necessity requirements with no substantive changes to billing, coding, or coverage rules.
Independence Blue Cross · Identified Jun 25, 2026Low impact
11.06.05f, Endometrial Ablation
Independence Blue Cross has reissued Medical Policy 11.06.05f on endometrial ablation to communicate its continuing position. No substantive changes to coverage criteria, contraindications, or billing codes were made in this reissue—the policy maintains existing coverage for endometrial ablation in premenopausal individuals with abnormal uterine bleeding unresponsive to hormone therapy, with the same contraindications and documentation requirements as previously established.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.06.05f, Endometrial Ablation
Independence Blue Cross reissued its Endometrial Ablation policy (11.06.05f) on 06/24/2026 to communicate the company's continuing position. This is a routine reissue with no substantive changes to coverage criteria, contraindications, or billing codes. The policy maintains coverage for endometrial ablation in premenopausal individuals with abnormal uterine bleeding who are unresponsive to hormone therapy, subject to documented medical necessity and absolute contraindications.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code N92.1?

There are 8 tracked policy changes affecting code N92.1, including updates from Regence BlueShield, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code N92.1?

Payers that have issued tracked updates for code N92.1 include: Regence BlueShield, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when code N92.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code N92.1. 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 N92.1?

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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Surgical Site of Care- Hospital Outpatient

Endometrial Ablation 4.01.01

Endometrial Cancer Screening, Diagnosis, and Prognosis (CPB 0769, reviewed 2025-10-03)

Estrogen Hormone Testing: Estradiol and Estrone

MA11.065d, Endometrial Ablation