Z13.79 Insurance Policy Changes

ICD-10 Z13.79 is officially defined as "Encounter for other screening for genetic and chromosomal anomalies." code Z13.79 is referenced in 6 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z13.79 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 Rhode Island · Effective Jul 1, 2025High impact
Medical policy updates
Effective July 1, 2025, clarifications for provider specialties were made to the outpatient professional behavioral health services policy for Medicare Advantage plans and commercial products. Effective September 1, 2025, transcranial magnetic stimulation (TMS) coverage changes from covered to covered only when filed with a covered ICD-10 code for the CPT codes in the TMS policy, for Medicare Advantage plans and commercial products. Effective September 1, 2025, prior authorization is removed for several genetic testing codes, and other codes move their medical criteria to the online authorization tool.
Excellus BlueCross BlueShield · Effective May 21, 2026Medium impact
Genetic Testing for Cardiac Ion Channelopathies 2.02.38
Excellus BlueCross BlueShield medical policy 2.02.38, Genetic Testing for Cardiac Ion Channelopathies, has a current effective date of May 21, 2026, and its annual review on that date left the policy intent unchanged. Genetic testing for congenital long QT syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT) and Brugada syndrome is medically appropriate when signs or symptoms are present but a definitive diagnosis cannot be made without it, or for at-risk individuals who have a qualifying first-, second- or third-degree relative, in each case only when the test results will influence treatment decisions. Genetic testing to determine future risk of short QT syndrome (SQTS) is medically appropriate for asymptomatic individuals who have a first-, second- or third-degree relative with a known SQTS variant.
Aetna · Identified Aug 19, 2026Medium impact
Invasive Prenatal Diagnosis of Genetic Diseases (CPB 0358, reviewed 2026-05-22)
Aetna's Clinical Policy Bulletin 0358 considers invasive prenatal diagnosis by chorionic villus sampling (CVS), genetic amniocentesis, and percutaneous umbilical blood sampling (PUBS, cordocentesis) medically necessary for diagnosing fetal chromosomal abnormalities. Preimplantation genetic testing for monogenic disorders (PGT-M) is medically necessary only when the listed criteria are met, including a known carrier parent for the specific indication, a specific identified mutation, and a procedure that eliminates the need for later invasive prenatal diagnosis. PGT-A, PGT-M for fetal chromosomal abnormalities, PGT-M to determine HLA status for stem cell donation, multigene panels at PGT-M testing, and invasive screening or PGT for a variant of uncertain significance are considered experimental, investigational, or unproven, as are the Igenomix PGT-M, PGT-SR, Smart PGT-A and Smart PGT-A Plus tests, the IriSight Prenatal Analysis, and the Natera Spectrum PGT-M test.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Genetic Testing for Neurofibromatosis
Genetic testing for NF1 or NF2 pathogenic variants may be considered medically necessary when a diagnosis of neurofibromatosis is clinically suspected due to signs of disease but a definitive diagnosis cannot be made without genetic testing. Genetic testing for NF1 or NF2 pathogenic variants in at-risk relatives with no signs of disease may be considered medically necessary when a definitive diagnosis cannot be made without genetic testing and a close relative (first-, second- or third-degree) has a known NF1 or NF2 variant or has been diagnosed with neurofibromatosis but whose genetic status is unavailable. Genetic testing for neurofibromatosis in all other situations is considered investigational.
Independence Blue Cross · Identified Jun 19, 2026Low impact
06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
This is a routine annual reissue of Independence Administrators' genetic testing policy for congenital Long QT Syndrome with no substantive changes to coverage criteria or billing codes. The policy clarifies that it applies only to members whose groups have NOT enrolled in the UM vendor program; groups with UM vendor enrollment should refer to the eviCore Lab Management Program instead.
Independence Blue Cross · Identified Jun 19, 2026Low impact
06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
This is a reissue of policy 06.02.31g with no substantive changes to coverage criteria for genetic testing of congenital Long QT Syndrome. The only modification is clarification of the applicability disclaimer: the policy now explicitly excludes groups enrolled in the UM vendor program, replacing the previous reference to eviCore Lab Management Program. Billing teams should verify member eligibility and UM vendor enrollment status before processing genetic testing claims.

Watch Z13.79

Get one email when a payer policy names Z13.79, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z13.79?

There are 6 tracked policy changes affecting code Z13.79, including updates from Blue Cross Blue Shield of Rhode Island, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z13.79?

Payers that have issued tracked updates for code Z13.79 include: Blue Cross Blue Shield of Rhode Island, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when code Z13.79 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z13.79. 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 Z13.79?

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

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Medical policy updates

Genetic Testing for Cardiac Ion Channelopathies 2.02.38

Invasive Prenatal Diagnosis of Genetic Diseases (CPB 0358, reviewed 2026-05-22)

Genetic Testing for Neurofibromatosis

06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)

06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)

What insurance policy changes affect code Z13.79?

Which payers have updated policy for code Z13.79?

How do I get notified when code Z13.79 policy changes?

Why do payers change policies for code Z13.79?