T85.44XS Insurance Policy Changes

ICD-10 T85.44XS is officially defined as "Capsular contracture of breast implant, sequela." code T85.44XS is referenced in 3 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code T85.44XS 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 Jul 9, 2025Medium impact
MA11.076g, Removal of Breast Implants
Independence Blue Cross updated MA11.076g to MA11.076h, removing coverage language that previously allowed reconstruction/replacement of breast implants for traumatic or surgically created deficits. CPT code 19370 was removed, and ICD-10 diagnosis codes were updated to add BIA-ALCL and gynecomatia-related codes while removing sequela and prosthetic status codes. The policy now emphasizes that removal is covered only when medical necessity criteria are met, with symmetry coverage available only when one implant requires removal due to a covered indication.
Aetna · Identified Aug 14, 2026Medium impact
Breast Ductal Lavage and Fiberoptic Ductoscopy (CPB 0517, reviewed 2026-08-05)
Aetna considers breast ductal lavage medically necessary as an alternative to aspiration for diagnosing non-lactational sporadic nipple discharge when a direct nipple aspirate yields too little cellular material for adequate cytological analysis. Fiberoptic ductoscopy combined with cytology testing is medically necessary for diagnosing intra-ductal lesions in women with non-lactational sporadic nipple discharge, and as a guide for resection of known breast intra-ductal cancer. Breast ductal lavage for breast cancer screening, breast cancer risk assessment, or any other indication not listed as medically necessary, ductal endoscopy combined with lavage in the contralateral breast of women with ipsilateral breast cancer, fiberoptic ductoscopy with the Acueity System for breast cancer screening, methylation analysis of ductal lavage samples for breast cancer risk, and miRNA analysis of breast ductal fluid for detecting breast cancer are considered experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Reduction Mammoplasty
Bilateral reduction mammoplasty in a female is considered medically necessary and not cosmetic when the listed clinical indications and documentation are present, including a minimum amount of breast tissue removed from each breast by patient height, from 300 grams under 5 feet to 400 grams over 5 feet 9 inches. Augmentation is not covered regardless of medical necessity, and liposuction for any condition, including reduction mammoplasty, is considered cosmetic. Mastectomy for gynecomastia in a male over 18 is medically necessary only when the tissue removed is glandular breast tissue and not the result of obesity, adolescence, or reversible drug effects.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code T85.44XS?

There are 3 tracked policy changes affecting code T85.44XS, including updates from Independence Blue Cross, 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 T85.44XS?

Payers that have issued tracked updates for code T85.44XS include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code T85.44XS policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T85.44XS. 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 T85.44XS?

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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MA11.076g, Removal of Breast Implants

Breast Ductal Lavage and Fiberoptic Ductoscopy (CPB 0517, reviewed 2026-08-05)

Reduction Mammoplasty

What insurance policy changes affect code T85.44XS?

Which payers have updated policy for code T85.44XS?

How do I get notified when code T85.44XS policy changes?

Why do payers change policies for code T85.44XS?