T82.855A Insurance Policy Changes

ICD-10 T82.855A is officially defined as "Stenosis of coronary artery stent, initial encounter." code T82.855A is referenced in 3 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code T82.855A is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 15, 2026Medium impact
Cardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve (CPB 0228, reviewed 2026-07-21)
Aetna considers cardiac CT and coronary CT angiography (CCTA) medically necessary when criteria are met, including CCTA on a 64-slice or greater scanner to rule out obstructive coronary stenosis in symptomatic persons with low or intermediate pre-test probability of coronary artery disease. Calcium scoring is covered for asymptomatic adults aged 40 to 75 with a borderline or intermediate (5% to 19.9%) 10-year risk of cardiac events who are not on a statin, have no history of diabetes, and have no family history of premature CAD. Aetna considers CCTA experimental, investigational or unproven for persons with a BMI greater than 40 (except when 3rd generation dual-source CT at 120 kV is used), for screening asymptomatic persons, and for persons with extensive coronary calcification or a prior Agatston score greater than 1000, and repeat calcium scoring is covered only when the most recent scan was zero, at least 5 years ago, and discovery of coronary calcium would change management.
Aetna · Identified Aug 15, 2026Medium impact
Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (CPB 0491, reviewed 2026-07-30)
Aetna considers coronary artery brachytherapy medically necessary as adjunctive treatment during a second angioplasty or stent placement when blockage has re-occurred within the localized area of a previously placed stent (in-stent re-stenosis), in native coronary arteries or coronary artery bypass grafts. Aetna also considers intravascular shockwave lithotripsy (IVL) medically necessary for hemodynamically significant, heavily calcified coronary stenoses (for example, calcium extending over 270 degrees) where primary stenting is not possible. Coronary artery brachytherapy is considered experimental, investigational, or unproven for primary prevention of re-stenosis and all other indications outside those listed.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Intracoronary Drug Delivery Balloon Procedures
Percutaneous coronary intervention with a drug-coated balloon for coronary in-stent restenosis in adult individuals is considered investigational under this policy, which was added on 04/01/2026. The AGENT paclitaxel-coated balloon received FDA premarket approval in February 2024 for in-stent restenosis in coronary arteries 2.0 mm to 4.0 mm in diameter with lesions up to 26 mm in length, and no drug-coated balloons are FDA-approved for de novo coronary lesions or small coronary vessel disease. Investigative treatments are not considered medically necessary, and Federal Employee Program members may have FDA-approved devices assessed only on the basis of medical necessity.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code T82.855A?

There are 3 tracked policy changes affecting code T82.855A, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code T82.855A?

Payers that have issued tracked updates for code T82.855A include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code T82.855A policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T82.855A. 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 T82.855A?

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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Cardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve (CPB 0228, reviewed 2026-07-21)

Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (CPB 0491, reviewed 2026-07-30)

Intracoronary Drug Delivery Balloon Procedures

What insurance policy changes affect code T82.855A?

Which payers have updated policy for code T82.855A?

How do I get notified when code T82.855A policy changes?

Why do payers change policies for code T82.855A?