N95.0 Insurance Policy Changes

ICD-10 N95.0 is officially defined as "Postmenopausal bleeding." code N95.0 is referenced in 9 tracked payer policy changes from Regence BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code N95.0 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.
Regence BlueShield · Effective Jul 1, 2026Medium impact
Hysterectomy
Effective July 1, 2026, hysterectomy may be considered medically necessary when the policy criteria are met for abnormal uterine bleeding, pelvic pain, endometriosis, chronic pelvic inflammatory disease, pelvic adhesive disease, pelvic venous congestion, adenomyosis, cervical intraepithelial neoplasia, or leiomyoma. Hysterectomy for these indications is considered not medically necessary when the criteria are not met, and clinical documentation supporting the criteria is required.
Aetna · Identified Oct 5, 2026Medium impact
Transvaginal Ultrasonography (CPB 0530, reviewed 2026-08-20)
Aetna's Clinical Policy Bulletin 0530 covers transvaginal ultrasonography (CPT 76817 and 76830) when selection criteria are met. Covered indications include assessment of fetal viability and gestational age in the first trimester, assessment of pelvic masses, abnormal uterine bleeding, monitoring of follicular development during infertility therapy, ectopic pregnancy, vasa previa, suspected endometriosis, and post-menopausal bleeding. The policy considers TVUS experimental, investigational or unproven for screening for endometrial, ovarian or other gynecologic cancers and for preoperative prediction of lymph node metastasis in cervical cancer.
Aetna · Identified Aug 18, 2026Medium impact
Testosterone Undecanoate (Aveed) Injection (CPB 0528, reviewed 2026-07-09)
Aetna's clinical policy for testosterone undecanoate (Aveed) injection covers it for commercial medical plans when it is medically necessary for primary hypogonadism or hypogonadotropic hypogonadism, or for gender dysphoria when prescribed for gender-affirming care, in each case under the listed criteria. Precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers age-related (late-onset) hypogonadism an exclusion for testosterone undecanoate therapy, and considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Fibroid Treatment (CPB 0304, reviewed 2026-04-17)
Aetna considers radiofrequency ablation or transcatheter uterine artery embolization medically necessary as an alternative to hysterectomy or myomectomy for uterine fibroids when the member has persistent symptoms directly attributed to the fibroids, such as excessive menstrual bleeding, bulk-related pelvic pain, pressure or discomfort, urinary symptoms from compression of the ureter or bladder, or dyspareunia. Aetna considers myomectomy or hysterectomy using power morcellation experimental, investigational, or unproven, except in women without known or strongly suspected uterine cancer who meet the listed exception criteria, such as premenopausal women who wish to maintain fertility and have no risk factors for uterine sarcoma. Aetna also considers cryomyolysis, cryotherapy, electrical ablation, interstitial thermotherapy, laparoscopic uterine artery occlusion, lasers, focused ultrasound ablation, acupuncture, and other uses of transcatheter uterine artery embolization experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)
Feraheme, Ferrlecit, Injectafer, Monoferric and Venofer are medically necessary only for commercial members who have a contraindication, intolerance or ineffective response to the lower cost alternatives generic ferumoxytol, generic iron sucrose, generic sodium ferric gluconate and INFeD (iron dextran) for the labeled indication. Precertification is required for Feraheme, Ferrlecit, generic sodium ferric gluconate, Injectafer, Monoferric, Venofer and generic iron sucrose in applicable plan designs. Intravenous iron is considered experimental, investigational or unproven for other indications, including acute mountain sickness and anemia of inflammation, and it is contraindicated for genetic hemochromatosis or hemochromatosis secondary to iron overload.
Aetna · Identified Aug 14, 2026Medium impact
Endometrial Ablation (CPB 0091, reviewed 2026-03-25)
Aetna considers endometrial ablation medically necessary for women with menorrhagia that is unresponsive to, or has a contraindication to, either dilation and curettage or hormonal therapy, when the severity and persistence of the bleeding would otherwise make the member a candidate for hysterectomy. The selection criteria also require that endometrial sampling or D&C was performed on the same day or within the year before the procedure to exclude cancer, pre-cancer or hyperplasia, that structural abnormalities requiring surgery were excluded, and that a Pap smear and gynecologic examination excluded significant cervical disease. Aetna considers endometrial ablation experimental, investigational, or unproven for all other indications, such as post-menopausal bleeding.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Endometrial Ablation
Endometrial ablation, with or without hysteroscopic guidance, using an FDA-approved device is medically necessary for women with abnormal uterine bleeding who are not candidates for, or are unresponsive to, hormone therapy and would otherwise be candidates for hysterectomy. Endometrial ablation is considered investigational for all other indications. The most recent policy review, dated 03/28/2025, reported no changes.
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).

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code N95.0?

There are 9 tracked policy changes affecting code N95.0, including updates from Regence BlueShield, 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 N95.0?

Payers that have issued tracked updates for code N95.0 include: Regence BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code N95.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code N95.0. 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 N95.0?

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

Hysterectomy

Transvaginal Ultrasonography (CPB 0530, reviewed 2026-08-20)

Testosterone Undecanoate (Aveed) Injection (CPB 0528, reviewed 2026-07-09)

Fibroid Treatment (CPB 0304, reviewed 2026-04-17)

Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)

Endometrial Ablation (CPB 0091, reviewed 2026-03-25)

Endometrial Ablation

Estrogen Hormone Testing: Estradiol and Estrone

What insurance policy changes affect code N95.0?

Which payers have updated policy for code N95.0?

How do I get notified when code N95.0 policy changes?

Why do payers change policies for code N95.0?