R35.0 Insurance Policy Changes

ICD-10 R35.0 is officially defined as "Frequency of micturition." code R35.0 is referenced in 11 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code R35.0 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 · Effective Oct 1, 2026Medium impact
Prostate Specific Antigen (PSA)
Effective 10/01/2026, the code reference adds ICD-10 diagnosis codes QA1.790 (familial cancer syndrome with pathogenic BRCA1 mutation), QA1.791 (familial cancer syndrome with pathogenic BRCA2 mutation), and QA1.792 (Li Fraumeni syndrome), which are listed among the medically necessary codes for prostate specific antigen testing. Prostate specific antigen may be considered medically necessary to differentiate benign from malignant prostate disease in men with listed lower urinary tract symptoms or abnormal studies, to follow prostate cancer after diagnosis, and to screen for malignant prostate disease with documented shared decision making. PSA is considered not medically necessary for all other indications.
Excellus BlueCross BlueShield · Effective Mar 16, 2026Medium impact
Sacral Nerve Stimulation 7.01.10
Excellus BlueCross BlueShield policy 7.01.10, Sacral Nerve Stimulation, has a current effective date of March 16, 2026. The November 20, 2025 off-cycle review clarified the sacral nerve stimulation trial and permanent placement criteria. Sacral nerve stimulation is medically appropriate for individuals 16 and older who meet both the trial stimulation and permanent placement criteria, and it is considered investigational for stress incontinence, urge incontinence due to a neurological condition, other chronic voiding dysfunction, constipation, chronic pelvic pain and bilateral sacral nerve stimulation.
Excellus BlueCross BlueShield · Effective Jan 1, 2026Medium impact
Tibial Nerve Stimulation (TNS) for Voiding Dysfunction 8.01.22
Percutaneous posterior tibial nerve stimulation is considered medically appropriate for urge urinary incontinence, nonobstructive urinary retention, or overactive bladder after at least three months of failed conservative behavioral therapy and failed pharmacological therapy or a contraindication to it, and for urge incontinence and overactive bladder that failure includes at least two anticholinergic or beta-3 adrenergic agonist medications or smooth muscle relaxants. Implanted tibial nerve stimulation is investigational for all indications, and percutaneous stimulation is investigational for voiding dysfunction due to a neurological condition, constipation, and fecal incontinence. A December 29, 2025 code edit added CPT codes 0988T and 0989T, effective January 1, 2026.
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.
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.
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.
Aetna · Identified Aug 18, 2026Medium impact
Urinary Incontinence (CPB 0223, reviewed 2026-07-16)
Aetna Clinical Policy Bulletin 0223 on urinary incontinence, reviewed 2026-07-16, considers multi-channel urodynamic studies medically necessary when a member has both symptoms and physical findings of urinary incontinence or voiding dysfunction and the provider is considering invasive, potentially morbid or irreversible treatment after conservative management has failed. It considers medically necessary the artificial urinary sphincter, FDA-cleared peri-urethral bulking agents, permanent sacral nerve stimulators after temporary trial stimulation, percutaneous tibial nerve stimulation, weighted vaginal cones, pessaries, tension-free and transobturator tape procedures, colposuspension and sub-urethral sling procedures when the stated criteria are met. Bilateral permanent sacral nerve stimulator implantation, the Genityte and FemiLift laser procedures, stem cell therapy and many other listed interventions are considered experimental, investigational or unproven.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Tibial Nerve Stimulation
A 09/15/2025 policy history entry retitled the policy from Percutaneous and Subcutaneous Tibial Nerve Stimulation to Tibial Nerve Stimulation and added a statement that transcutaneous tibial nerve stimulation (e.g., Vivally System) is investigational for individuals with urge urinary incontinence and urinary urgency. HCPCS codes A4545, E0736 and E0737 were added to the investigational codes table. Percutaneous tibial nerve stimulation is medically necessary for an initial 12-week course for non-neurogenic urinary dysfunction, including overactive bladder, after failed behavioral therapy and failed pharmacologic therapy, and for monthly maintenance after an initial course that resulted in improved urinary dysfunction meeting treatment goals.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code R35.0?

There are 11 tracked policy changes affecting code R35.0, including updates from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R35.0?

Payers that have issued tracked updates for code R35.0 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna, Health Net.

How do I get notified when code R35.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R35.0. 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 R35.0?

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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Prostate Specific Antigen (PSA)

Sacral Nerve Stimulation 7.01.10

Tibial Nerve Stimulation (TNS) for Voiding Dysfunction 8.01.22

Sacral Nerve Neuromodulation Stimulation

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

26-1101m Updates to Clinical Policies – August 2026

26-1102m Updates to Clinical Policies – August 2026

26-1103m Updates to Clinical Policies – August 2026

Urinary Incontinence (CPB 0223, reviewed 2026-07-16)

Sacral Nerve Neuromodulation/Stimulation

Tibial Nerve Stimulation

What insurance policy changes affect code R35.0?

Which payers have updated policy for code R35.0?

How do I get notified when code R35.0 policy changes?

Why do payers change policies for code R35.0?