Z79.811 Insurance Policy Changes

ICD-10 Z79.811 is officially defined as "Long term (current) use of aromatase inhibitors." code Z79.811 is referenced in 5 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z79.811 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
Bone Mineral Density Studies
Bone density measurements are covered once per lifetime for general osteoporosis screening for women beginning at age 65 under the Healthy You! Wellness benefit, and screening is limited to the hips or spine using DEXA. An initial hip or spine measurement may be considered medically necessary for women age 65 and older, men age 70 and older, and others at risk of osteoporosis, and repeat measurements may be considered not more often than every 5 years for at-risk individuals who previously tested normal. The 10/01/2026 update added ICD-10 codes K74.0A, K76.83, Z68.18 and Z68.19, and Z68.1 was deleted as of 09/30/2026.
Aetna · Identified Sep 30, 2026Medium impact
Denosumab (CPB 0804, reviewed 2026-08-21)
Aetna covers Prolia and its ten listed biosimilars, and Xgeva and its nine listed biosimilars, under commercial medical plans, and precertification is required for these denosumab products in applicable plan designs. Prolia is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, bone loss in men receiving androgen deprivation therapy for prostate cancer, bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer, and inhibiting progression of bone erosion in rheumatoid arthritis, based on criteria such as fragility fracture history, pre-treatment T-score, pre-treatment FRAX probability, and prior therapy response or intolerance. Xgeva is considered medically necessary for multiple myeloma, bone metastases from solid tumors, giant cell tumor of bone, hypercalcemia of malignancy refractory to intravenous bisphosphonate therapy, and second-line therapy for osteopenia or osteoporosis in systemic mastocytosis, and continuation of Xgeva requires disease stability or improvement.
Aetna · Identified Aug 19, 2026Medium impact
Zoledronic Acid (CPB 0524, reviewed 2026-02-12)
Aetna's clinical policy bulletin covers zoledronic acid for commercial medical plans. Zoledronic acid 5 mg (Reclast or generic) is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget's disease of bone, and treatment-related bone loss in men with prostate cancer receiving androgen deprivation therapy, when the listed criteria are met. Zoledronic acid 4 mg (formerly branded Zometa) is considered medically necessary for bone metastases from a solid tumor, certain breast cancer indications, hypercalcemia of malignancy, Langerhans cell histiocytosis with bone disease, multiple myeloma, and systemic mastocytosis with osteopenia or osteoporosis. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Denosumab (CPB 0804, reviewed 2026-06-08)
Aetna's commercial medical policy sets coverage criteria for Prolia and its biosimilars and for Xgeva and its biosimilars, and precertification is required for these products in applicable plan designs. Prolia and its biosimilars are considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, bone loss in men receiving androgen deprivation therapy for prostate cancer, bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer, and inhibiting progression of bone erosion in rheumatoid arthritis. Xgeva and its biosimilars are considered medically necessary for multiple myeloma, bone metastases from a solid tumor, giant cell tumor of bone, hypercalcemia of malignancy refractory to intravenous bisphosphonate therapy, and second-line therapy for osteopenia or osteoporosis in systemic mastocytosis. All other indications are considered experimental, investigational, or unproven, and combination therapy of denosumab with intravenous bisphosphonates is also considered experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Estrogen Hormone Testing: Estradiol and Estrone
Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism, to diagnose hyperestrogenism in symptomatic males, to monitor hormone replacement therapy in postmenopausal females, and to monitor antiestrogen therapy. Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients. The covered tests are total estradiol (CPT 82670), fractionated estrogens (CPT 82671), total estrogens (CPT 82672), estrone (CPT 82679), and free estradiol by direct measurement, such as equilibrium dialysis (CPT 82681).

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z79.811?

There are 5 tracked policy changes affecting code Z79.811, including updates from Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z79.811?

Payers that have issued tracked updates for code Z79.811 include: Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code Z79.811 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z79.811. 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 Z79.811?

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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Bone Mineral Density Studies

Denosumab (CPB 0804, reviewed 2026-08-21)

Zoledronic Acid (CPB 0524, reviewed 2026-02-12)

Denosumab (CPB 0804, reviewed 2026-06-08)

Estrogen Hormone Testing: Estradiol and Estrone

What insurance policy changes affect code Z79.811?

Which payers have updated policy for code Z79.811?

How do I get notified when code Z79.811 policy changes?

Why do payers change policies for code Z79.811?