Z80.0 Insurance Policy Changes

ICD-10 Z80.0 is officially defined as "Family history of malignant neoplasm of digestive organs." code Z80.0 is referenced in 7 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 Z80.0 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
Germline Genetic Testing for Hereditary Diffuse Gastric Cancer (CDH1, CTNNA1)
Germline CDH1 testing for hereditary diffuse gastric cancer may be considered medically necessary when individuals meet listed criteria, such as a diagnosis of diffuse gastric cancer before age 50, a diagnosis of diffuse gastric cancer at any age in individuals of Maori ethnicity or with a personal or family history of cleft lip/palate, or a diagnosis of bilateral lobular breast cancer before age 70. CDH1 testing for individuals who do not meet these criteria, and CTNNA1 testing, are considered investigational. The code reference section was updated on 10/01/2026 to add ICD-10 diagnosis code QA1.71.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2)
Genetic testing for BRCA1, BRCA2 and PALB2 variants may be considered medically necessary in individuals with cancer who meet listed criteria, such as a personal history of breast cancer diagnosed at age 45 years or younger, a personal history of epithelial ovarian carcinoma at any age, or a personal history of exocrine pancreatic cancer at any age. Testing of BRCA1 and BRCA2 in individuals with a family history of cancer who do not meet the criteria, testing of PALB2 in individuals who do not meet the criteria, and genetic testing in minors are considered investigational. The code reference section was updated on 10/01/2026 to add ICD-10 diagnosis codes QA1.790 and QA1.791 and to remove deleted CPT code 96040.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
Already effective 10/01/2026: ICD-10 diagnosis code QA1.71 was added for Lynch syndrome. Genetic testing of the APC gene may be considered medically necessary for at-risk relatives of individuals with familial adenomatous polyposis or a known APC variant, and for individuals with a differential diagnosis of attenuated FAP, MUTYH-associated polyposis, or Lynch syndrome. Genetic testing of MMR genes (MLH1, MSH2, MSH6, PMS2) may be considered medically necessary for individuals with colorectal or endometrial cancer whose tumor testing suggests germline MMR deficiency or who meet clinical criteria for Lynch syndrome, and for individuals without cancer who meet the Amsterdam or Revised Bethesda criteria or have a 5% or higher predicted risk on a validated risk prediction model when no affected family members have been tested. Testing for germline APC, MUTYH, MMR, EPCAM, SMAD4, BMPR1A, and STK11 variants for inherited colorectal cancer syndromes is considered investigational in all other situations.
Excellus BlueCross BlueShield · Effective Apr 16, 2026Medium impact
Germline Genetic Testing for Hereditary Cancers 2.02.60
Excellus BlueCross BlueShield policy 2.02.60 considers germline genetic testing for hereditary cancer medically appropriate in listed circumstances, including when a blood relative has a known pathogenic or likely pathogenic variant, when a pathogenic or likely pathogenic variant is found on tumor genomic testing, when results aid systemic therapy or surgical decisions, and when individuals meet specific criteria for breast, ovarian, pancreatic, prostate, colorectal, Cowden syndrome, Li-Fraumeni syndrome, hereditary diffuse gastric cancer or familial medullary thyroid carcinoma. Multigene panel testing is considered medically appropriate when an individual meets Policy Statement I, except Policy Statements I.A, I.D and I.G.9. The current effective date is April 16, 2026, and the annual update kept the policy intent unchanged.
Aetna · Identified Aug 17, 2026Medium impact
Genetic Counseling (CPB 0189, reviewed 2026-03-27)
Aetna considers genetic counseling medically necessary for listed pregnancy-related indications, including couples who are closely related genetically, familial cancer disorders, pregnant women with maternal age 35 years or greater at delivery, and parents of a child born with a genetic disorder or birth defect. Genetic counseling unrelated to pregnancy is covered when it is appropriate for, or provided with, medically necessary genetic testing in accordance with ACMG guidelines. Genetic counseling for all other indications is considered experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Colonoscopy, Colorectal Cancer Screening, and Related Procedures (CPB 0516, reviewed 2025-11-12)
Aetna considers colorectal cancer screening medically necessary for average-risk members aged 45 years and older when their physician recommends it, with colonoscopy every 10 years, CT colonography every 5 years, annual FIT or FOBT, flexible sigmoidoscopy every 5 years, flexible sigmoidoscopy every 10 years when combined with annual FIT or FOBT, and stool DNA every 1 to 3 years. Colonoscopy or sigmoidoscopy as frequently as every 2 years is considered medically necessary for members with a first-degree relative who had CRC or adenomatous polyps, familial adenomatous polyposis, hereditary non-polyposis CRC, MYH-associated polyposis in siblings, or Cowden syndrome, and surveillance is considered medically necessary as frequently as every year for inflammatory bowel disease or a personal history of CRC. Double contrast barium enema is not considered medically necessary, and AI-aided colonoscopy, blood-based biomarkers, Guardant Shield, stool-based protein biomarkers, fecal volatile organic compound analysis, anal Pap smear, drug-coated balloons for colonic strictures, and the full-thickness resection device for appendiceal polyps are considered experimental, investigational or unproven.
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 Z80.0?

There are 7 tracked policy changes affecting code Z80.0, 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 Z80.0?

Payers that have issued tracked updates for code Z80.0 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna.

How do I get notified when code Z80.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z80.0. 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 Z80.0?

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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Germline Genetic Testing for Hereditary Diffuse Gastric Cancer (CDH1, CTNNA1)

Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2)

Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes

Germline Genetic Testing for Hereditary Cancers 2.02.60

Genetic Counseling (CPB 0189, reviewed 2026-03-27)

Colonoscopy, Colorectal Cancer Screening, and Related Procedures (CPB 0516, reviewed 2025-11-12)

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

What insurance policy changes affect code Z80.0?

Which payers have updated policy for code Z80.0?

How do I get notified when code Z80.0 policy changes?

Why do payers change policies for code Z80.0?