Q23.0 Insurance Policy Changes

ICD-10 Q23.0 is officially defined as "Congenital stenosis of aortic valve." code Q23.0 is referenced in 11 tracked payer policy changes from Independence Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Q23.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Sep 10, 2026High impact
MA11.027h, Transcatheter Cardiac Valve Procedures
Independence Blue Cross updated MA11.027h to align TAVR coverage with CMS National Coverage Determination. Symptomatic severe aortic stenosis coverage changed from experimental/investigational (with CED exception) to medically necessary; asymptomatic aortic stenosis remains experimental/investigational except under CED. This expands coverage eligibility and requires billing teams to verify heart team documentation, FDA-approved valve systems, and specific clinical evaluations prior to claim submission.
Independence Blue Cross · Effective Jul 2, 2025Medium impact
MA11.027g, Transcatheter Cardiac Valve Procedures
Independence Blue Cross updated MA policy MA11.027g to MA11.027h, adding coverage for transcatheter tricuspid valve repair procedures (CPT codes 0569T and 0570T) under a Coverage with Evidence Development (CED) program, effective July 2, 2025. The policy was reissued on April 1, 2026 to communicate the company's continuing position on transcatheter cardiac valve procedures.
Independence Blue Cross · Effective Jul 2, 2025Medium impact
MA11.027g, Transcatheter Cardiac Valve Procedures
Independence Blue Cross has reissued MA11.027g (now superseded by MA11.027h) to communicate updated coverage criteria for transcatheter cardiac valve procedures, specifically adding CPT codes 0569T and 0570T for transcatheter edge-to-edge repair of tricuspid valve regurgitation under Medicare's Coverage with Evidence Development (CED) program effective 07/02/2025.
Aetna · Identified Oct 29, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)
Aetna considers transcatheter aortic valve implantation (TAVI) medically necessary when criteria are met. Those criteria cover severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and an ejection fraction greater than 20%, and valve-in-valve replacement of a degenerated bioprosthetic aortic valve in patients with a Society of Thoracic Surgeons operative risk score of 8% or greater or a judged 15% or greater risk of mortality from surgical replacement. Percutaneous repair of prosthetic paravalvular leak is also considered medically necessary under specific conditions, while BASILICA, combined TAVI and left atrial appendage occlusion, embolic protection devices, TAVI for ongoing sepsis or endocarditis, and several prognostic tests are listed as experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)
Aetna Clinical Policy Bulletin 0826 covers transcatheter aortic valve implantation (TAVI). Aetna considers TAVI with an FDA-approved valve medically necessary for severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and with an ejection fraction greater than 20%, and for valve-in-valve replacement of a degenerated bioprosthetic aortic valve when the STS operative risk score is 8% or greater or the member is judged to be at 15% or greater risk of mortality for surgical aortic valve replacement. Percutaneous repair of prosthetic paravalvular leak is medically necessary when intractable hemolysis or NYHA class III or IV symptoms, high or prohibitive surgical risk, suitable anatomy and a comprehensive valve center are all met, and BASILICA, combined TAVI and left atrial appendage occlusion, pre-implantation balloon aortic valvuloplasty, embolic protection devices, and TAVI for sepsis, bicuspid aortic stenosis, native aortic valve regurgitation or porcelain aorta are listed as experimental, investigational or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Selected Aortic Valve Procedures (CPB 0407, reviewed 2026-07-07)
Aetna considers the Ross pulmonary autograft procedure medically necessary for aortic valve replacement caused by congenital anomalies or aortic valve disease, and considers aortic valve-sparing re-implantation medically necessary for secondary aortic regurgitation from aortic root dilatation, such as in Marfan syndrome, and for type A acute aortic dissections. The Ross procedure and aortic valve-sparing re-implantation are considered experimental, investigational, or unproven for all other indications, and so are the Florida Sleeve valve-sparing procedure, Personalized External Aortic Root Support (PEARS), and the Matrix P bioprosthesis for pulmonary valve replacement in Ross procedures. the policy was last reviewed 07/07/2026.
Aetna · Identified Aug 14, 2026Medium impact
Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)
Balloon valvuloplasty is medically necessary for severe rheumatic mitral stenosis, severe aortic stenosis, and pulmonary valve stenosis when the listed criteria are met. For mitral stenosis with favorable valve anatomy, the criteria include a cumulative echocardiographic score of 8 or less. Balloon dilation for all other indications not listed is experimental, investigational, or unproven, including balloon aortic valvuloplasty used to select transcatheter heart valve size and percutaneous balloon valvuloplasty for bioprosthetic tricuspid valve stenosis.
Aetna · Identified Aug 13, 2026Medium impact
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-02-19)
Aetna Clinical Policy Bulletin 0558 considers percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion medically necessary for hypertrophic obstructive cardiomyopathy (HOCM) in adults 21 years of age and older when all listed criteria are met, including severe symptoms despite optimal drug therapy, NYHA class III or IV, a peak LVOT gradient of at least 50 mm Hg, and suitable coronary anatomy with an identifiable septal perforator artery. Aetna also considers PTSMA medically necessary for carefully selected members 5 to 20 years of age with HOCM when the pediatric criteria are met, and it considers PTSMA for all other indications, SESAME, and ultrasound-guided PTSMA experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Palivizumab (Synagis) (CPB 0318, reviewed 2025-11-24)
Aetna considers palivizumab (Synagis) medically necessary for commercial medical plans for up to 5 doses per RSV season to prevent serious lower respiratory tract disease caused by RSV, when a member has a qualifying diagnosis such as prematurity, chronic lung disease of prematurity, hemodynamically significant congenital heart disease, cystic fibrosis or profound immunocompromise and the associated criteria are met. Palivizumab is excluded for members who have received nirsevimab-alip (Beyfortus) in the same RSV season. The American Academy of Pediatrics stated that in July 2025 it no longer routinely recommends using Synagis.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.02.25j, Transcatheter Cardiac Valve Procedures
Independence Blue Cross has reissued policy 11.02.25k for Transcatheter Cardiac Valve Procedures, superseding version 11.02.25j. The policy continues to cover TAVR for native valve aortic stenosis and degenerated bioprosthetic valves ('valve-in-valve') under specified clinical criteria. An ICD-10 code (Q23.88) was added in October 2024 for congenital malformations of aortic and mitral valves. No substantive coverage changes are documented; this is a routine policy reissuance communicating the company's continuing position.
Independence Blue Cross · Identified Jun 19, 2026Low impact
11.02.25j, Transcatheter Cardiac Valve Procedures
Independence Blue Cross reissued policy 11.02.25k for Transcatheter Cardiac Valve Procedures, maintaining the company's continuing position on TAVR coverage. The policy was updated to include new ICD-10 code Q23.88 (Other congenital malformations of aortic and mitral valves) effective 10/01/2024. No substantive changes to medical necessity criteria, coverage requirements, or billing codes occurred in the most recent 04/01/2026 reissuance.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Q23.0?

There are 11 tracked policy changes affecting code Q23.0, including updates from Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Q23.0?

Payers that have issued tracked updates for code Q23.0 include: Independence Blue Cross, Aetna.

How do I get notified when code Q23.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Q23.0. 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 Q23.0?

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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MA11.027h, Transcatheter Cardiac Valve Procedures

MA11.027g, Transcatheter Cardiac Valve Procedures

MA11.027g, Transcatheter Cardiac Valve Procedures

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)

Selected Aortic Valve Procedures (CPB 0407, reviewed 2026-07-07)

Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)

Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-02-19)

Palivizumab (Synagis) (CPB 0318, reviewed 2025-11-24)

11.02.25j, Transcatheter Cardiac Valve Procedures

11.02.25j, Transcatheter Cardiac Valve Procedures

What insurance policy changes affect code Q23.0?

Which payers have updated policy for code Q23.0?

How do I get notified when code Q23.0 policy changes?

Why do payers change policies for code Q23.0?