Z40.02 Insurance Policy Changes

ICD-10 Z40.02 is officially defined as "Encounter for prophylactic removal of ovary(s)." code Z40.02 is referenced in 4 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z40.02 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
Prophylactic Oophorectomy
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). Prophylactic oophorectomy is considered medically necessary in women with a confirmed BRCA mutation, and in women who are verified members of a site-specific ovarian cancer family, after childbearing has been completed or after age 35, when appropriate genetic counseling and an accurate risk assessment have been performed. It is considered investigational for women in HNPCC families, for women with relatives with breast or ovarian cancer who are not verified site-specific family members or verified BRCA carriers, and for women at average risk.
Excellus BlueCross BlueShield · Effective Aug 20, 2026Medium impact
Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy 10.01.01
Excellus policy 10.01.01 considers reconstructive breast surgery during or after mastectomy, including partial mastectomy for benign or malignant disease, medically appropriate. Covered services may include breast implants, abdominal flap reconstruction, chest wall reconstruction, nipple and areola reconstruction and tattooing, surgery for symmetry of the opposite breast, basic breast prostheses, mastectomy bras, and treatment of physical complications of mastectomy including lymphedema. A risk-reducing mastectomy is considered medically appropriate for individuals with lobular carcinoma in situ, a known BRCA1 or BRCA2 variant, another high-risk gene variant, or chest radiotherapy between ages 10 and 30, and the 08/20/26 annual review states that policy intent is unchanged.
Aetna · Identified Aug 19, 2026Medium impact
Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)
Aetna considers breast MRI medically necessary for members who had a recent (within the past year) conventional mammogram and/or breast sonogram, when MRI may affect clinical management. Covered circumstances include detecting local tumor recurrence after mastectomy and breast reconstruction with an implant, assessing residual cancer after an incomplete lumpectomy, and adjunct screening to mammography for women at high genetic risk or with a lifetime breast cancer risk of 20 to 25 percent or more. Breast MRI is considered experimental, investigational or unproven for listed uses such as screening women with average breast cancer risk, evaluating BI-RADS 4 or 5 lesions found on mammogram or ultrasound, and screening women with dense breasts who are asymptomatic and have no additional risk factors. Computer-aided detection is considered integral to breast MRI and is not separately reimbursed.
Aetna · Identified Aug 14, 2026Medium impact
Breast and Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy (CPB 0227, reviewed 2026-04-14)
Aetna considers prophylactic mastectomy medically necessary for reduction of breast cancer risk in listed high-risk women, including women diagnosed with breast cancer at 45 years of age or younger, women with a BRCA1 or BRCA2 mutation confirmed by molecular susceptibility testing, and women who received radiation treatment to the chest between ages 10 and 30. Prophylactic bilateral oophorectomy or salpingo-oophorectomy is medically necessary for selected women with listed risk factors who meet specific family history or germline mutation criteria, and germline multigene panel testing is medically necessary once per lifetime for persons who meet one or more NCCN testing criteria for high-penetrance breast cancer susceptibility genes. Testing for BARD1, MUTYH, NBN, and other genes or indications not listed in the policy is not covered.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z40.02?

There are 4 tracked policy changes affecting code Z40.02, 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 Z40.02?

Payers that have issued tracked updates for code Z40.02 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna.

How do I get notified when code Z40.02 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z40.02. 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 Z40.02?

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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Prophylactic Oophorectomy

Breast Reconstruction Surgery and Prophylactic Breast Cancer Risk-Reducing Mastectomy 10.01.01

Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)

Breast and Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy (CPB 0227, reviewed 2026-04-14)

What insurance policy changes affect code Z40.02?

Which payers have updated policy for code Z40.02?

How do I get notified when code Z40.02 policy changes?

Why do payers change policies for code Z40.02?