R91.8 Insurance Policy Changes

ICD-10 R91.8 is officially defined as "Other nonspecific abnormal finding of lung field." code R91.8 is referenced in 5 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, 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 R91.8 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 North Dakota · Effective Jan 1, 2026High impact
Medical Policies Updates
The following medical policies take effect Jan. 1, 2026: new policies for Aqueous Shunts and Stents for Glaucoma, Computerized Corneal Topography, Renal Denervation System, Skin Substitutes, Supplementary Algorithm for Cardiac Magnetic Resonance Imaging, and Fibrin Sealant, along with revised policies including Patient Lifts, Biofeedback, Intensity-Modulated Radiotherapy, and Electrical Nerve Stimulation. Coding changes effective Oct. 1, 2025 added new codes E0150, A9288, L1007, and A9616 for their listed services, and many policies removed G35 from covered diagnosis codes and added G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, and G35.D. Cervical Fusions, Corneal Topography, Amniotic Membrane and Amniotic Fluid, and Bioengineered Skin and Soft Tissue Substitutes policies will be archived or retired.
Excellus BlueCross BlueShield · Effective Oct 22, 2026Medium impact
Molecular Testing in the Management of Pulmonary Nodules 2.02.58
Policy 2.02.58 considers molecular testing for undiagnosed pulmonary nodules investigational in all circumstances, including plasma-based proteomic screening, gene expression of bronchial brushings or nasal swabs, and flow cytometry of sputum. The policy names CyPath Lung, EarlyCDT Lung, LungLB, Nodify CDT, Nodify XL2, OncobiotaLUNG, ReVeal Lung Nodule Characterization, PAULA's Test, Percepta Genomic Sequencing Classifier and Percepta Nasal Swab as investigational tests. The current effective date is October 22, 2026, and the 10/22/26 annual review left the policy intent unchanged.
Aetna · Identified Aug 14, 2026Medium impact
Electromagnetic Navigation-Guided Bronchoscopy (CPB 0776, reviewed 2026-06-08)
This electromagnetic navigation (EN)-guided bronchoscopy policy was last reviewed June 8, 2026. EN-guided bronchoscopy is medically necessary for the pathologic diagnosis of a peripheral pulmonary nodule that cannot be reached by standard bronchoscopy or a transthoracic biopsy approach, and for transbronchial dye injection to mark pulmonary nodules before resection by thoracoscopic surgery. Cone-beam CT augmented EN-guided bronchoscopy for biopsy of indeterminate pulmonary nodules, EN-guided microwave ablation, EN bronchoscopy with non-thermal ablation (electroporation), and trans-bronchial lung cryo-biopsy to improve the diagnostic yield of digital tomosynthesis-assisted EN-guided biopsy are experimental, investigational or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Single Photon Emission Computed Tomography (SPECT) (CPB 0376, reviewed 2026-05-28)
Aetna's Clinical Policy Bulletin 0376 sets the coverage rules for single photon emission computed tomography (SPECT). Non-cardiac SPECT is considered medically necessary for a list of indications, including osteomyelitis, distinguishing bone from soft tissue infection, pulmonary embolism by SPECT ventilation/perfusion scintigraphy, distinguishing Parkinson's disease from essential tremor using DaTSCAN, localization of abscesses, lymphoma and necrosis differentiation, neuroendocrine tumor diagnosis and staging, presurgical ictal detection of seizure focus in epilepsy in place of PET, and thyroid cancer iodine imaging. SPECT for coronary artery disease diagnosis and prognosis is considered medically necessary, except as outlined in the policy's exclusion criteria. SPECT for a list of other uses, including Alzheimer's disease and dementia, attention deficit/hyperactivity disorder, autism, schizophrenia, stroke, and absolute quantitation of myocardial blood flow, is considered experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Electromagnetic Navigation Bronchoscopy
Electromagnetic navigation bronchoscopy may be considered medically necessary to establish a diagnosis of suspicious peripheral pulmonary lesions or to place fiducial markers within lung tumors before treatment, when flexible bronchoscopy alone or with endobronchial ultrasound is considered inadequate for the diagnostic or interventional objective. It is considered investigational for use with flexible bronchoscopy to diagnose mediastinal lymph nodes and for all other uses not covered above. The policy history records a 10/19/2026 description update on new lung cancer data, with policy statements unchanged.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code R91.8?

There are 5 tracked policy changes affecting code R91.8, including updates from Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R91.8?

Payers that have issued tracked updates for code R91.8 include: Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code R91.8 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R91.8. 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 R91.8?

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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Medical Policies Updates

Molecular Testing in the Management of Pulmonary Nodules 2.02.58

Electromagnetic Navigation-Guided Bronchoscopy (CPB 0776, reviewed 2026-06-08)

Single Photon Emission Computed Tomography (SPECT) (CPB 0376, reviewed 2026-05-28)

Electromagnetic Navigation Bronchoscopy

What insurance policy changes affect code R91.8?

Which payers have updated policy for code R91.8?

How do I get notified when code R91.8 policy changes?

Why do payers change policies for code R91.8?