R33.0 Insurance Policy Changes

ICD-10 R33.0 is officially defined as "Drug induced retention of urine." code R33.0 is referenced in 5 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi and Health Net. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code R33.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross & Blue Shield of Mississippi · Identified Oct 17, 2026Medium impact
Sacral Nerve Neuromodulation Stimulation
Policy A.7.01.69 states that sacral nerve neuromodulation may be considered medically necessary as a trial for urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder when the listed criteria are met, and as a trial for chronic fecal incontinence when its separate criteria are met. Permanent implantation may be considered medically necessary when those criteria are met and a trial stimulation period shows at least 50% improvement in symptoms over at least 48 hours, while chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition are investigational. The policy was updated on 09/17/2026 to change the device description, renumber the urinary incontinence Criteria A statements, and remove ICD-9 procedure and diagnosis codes from the code reference section.
Health Net · Identified Sep 25, 2026Medium impact
26-1101m Updates to Clinical Policies – August 2026
CalViva Health (Health Net's Medi-Cal plan in California) updated seven clinical policies, with the source stating they were approved for and effective in August 2026, so those changes are already in effect. The changes add or delete diagnosis and CPT codes for urodynamic testing, genitourinary and GI pathogen panels, narrow the criteria for selective nerve root blocks and epidural steroid injections, and tighten documentation rules for applied behavior analysis services.
Health Net · Identified Sep 25, 2026Medium impact
26-1102m Updates to Clinical Policies – August 2026
Community Health Plan of Imperial Valley (a Medi-Cal plan in Imperial County, California) updated seven clinical policies, with the source stating they were approved for and effective in August 2026, so those changes are already in effect. The changes add or delete diagnosis and CPT codes for urodynamic testing, genitourinary and GI pathogen panels, narrow the criteria for selective nerve root blocks and epidural steroid injections, and tighten documentation rules for applied behavior analysis services.
Health Net · Identified Sep 25, 2026Medium impact
26-1103m Updates to Clinical Policies – August 2026
Health Net's August 2026 clinical policy update changes medical necessity criteria and code lists in several policies. The biggest change is that selective nerve root blocks are now for diagnostic purposes only, with therapeutic indications removed, and the notice also updates ICD-10 and CPT lists for urodynamic testing, GI pathogen panels, vaginitis testing and vagus nerve stimulation. The notice gives no day-level effective date beyond August 2026, so treat these changes as already in effect and check the full policies in the Provider Library.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Sacral Nerve Neuromodulation/Stimulation
A trial of sacral nerve neuromodulation, using percutaneous nerve stimulation or a temporarily implanted lead, may be considered medically necessary for urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder when the listed criteria are met. Permanent implantation may be considered medically necessary when those criteria are met and a trial stimulation period demonstrates at least 50% improvement in symptoms over at least 48 hours. For chronic fecal incontinence, a trial may be considered for more than 2 incontinent episodes on average per week for more than 6 months, or more than 12 months after vaginal childbirth, after documented failure of conventional conservative therapy. Sacral nerve neuromodulation is considered investigational for chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition. The 09/17/2026 update revised device descriptions, re-numbered the Criteria A statements for urinary incontinence, and removed ICD-9 procedure and diagnosis codes from the code reference.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code R33.0?

There are 5 tracked policy changes affecting code R33.0, including updates from Blue Cross & Blue Shield of Mississippi, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R33.0?

Payers that have issued tracked updates for code R33.0 include: Blue Cross & Blue Shield of Mississippi, Health Net.

How do I get notified when code R33.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R33.0. 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 R33.0?

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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Sacral Nerve Neuromodulation Stimulation

26-1101m Updates to Clinical Policies – August 2026

26-1102m Updates to Clinical Policies – August 2026

26-1103m Updates to Clinical Policies – August 2026

Sacral Nerve Neuromodulation/Stimulation

What insurance policy changes affect code R33.0?

Which payers have updated policy for code R33.0?

How do I get notified when code R33.0 policy changes?

Why do payers change policies for code R33.0?