What insurance policy changes affect code O92.79?

There are 3 tracked policy changes affecting code O92.79, including updates from Horizon BCBS NJ, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code O92.79?

Payers that have issued tracked updates for code O92.79 include: Horizon BCBS NJ, Aetna.

How do I get notified when code O92.79 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code O92.79. 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 O92.79?

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.

PAYER POLICY CHANGES

O92.79 Insurance Policy Changes

ICD-10 O92.79 is officially defined as "Other disorders of lactation." code O92.79 is referenced in 3 tracked payer policy changes from Horizon BCBS NJ and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code O92.79 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Horizon BCBS NJ · Effective Jan 1, 2026High impact
Statin Use in Persons with Diabetes (SUPD)
This is a new Medicare Part D Star Ratings measure (SUPD) effective for 2026 that evaluates whether patients ages 40-75 with diabetes on antidiabetic medications are also receiving statin therapy. Billing teams must ensure proper documentation and ICD-10 coding of exclusionary diagnoses to accurately track eligible patients and avoid measure performance penalties. Claims must include appropriate exclusion codes when patients have contraindications to statin therapy.
Aetna · Identified Oct 3, 2026Medium impact
Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-10-01)
Aetna's Clinical Policy Bulletin 0954 covers romosozumab-aqqg (Evenity) for commercial medical plans when treating postmenopausal osteoporosis in members with a history of fragility fractures, or with a pre-treatment T-score of -2.5 or lower, or with osteopenia and a high pre-treatment FRAX probability plus one of the listed risk or prior-therapy criteria. Treatment is limited to 12 monthly doses, and monthly injections are considered contraindicated and not medically necessary for members who have had a myocardial infarction or stroke within the preceding year. Glucocorticoid-induced osteoporosis, rheumatoid arthritis, osteoporosis related to maintenance hemodialysis, osteogenesis imperfecta, and several other indications are listed as experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-02-20)
For commercial plans, Aetna considers romosozumab-aqqg (Evenity) medically necessary for postmenopausal osteoporosis when a member has a history of fragility fractures, or a pre-treatment T-score less than or equal to -2.5, or osteopenia with a high pre-treatment FRAX probability plus very high fracture risk indicators, an inadequate response or intolerance to previous injectable osteoporosis therapy, or an inadequate response or intolerance to oral bisphosphonate therapy. Continuation is medically necessary for members who meet all initial selection criteria and have received less than 12 monthly doses. Aetna considers it contraindicated and not medically necessary for members who have had a myocardial infarction or stroke within the preceding year, and experimental, investigational or unproven for glucocorticoid-induced osteoporosis, rheumatoid arthritis, and several other listed indications.

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Statin Use in Persons with Diabetes (SUPD)

Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-10-01)

Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-02-20)

What insurance policy changes affect code O92.79?

Which payers have updated policy for code O92.79?

How do I get notified when code O92.79 policy changes?

Why do payers change policies for code O92.79?