Z85.048 Insurance Policy Changes

ICD-10 Z85.048 is officially defined as "Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus." code Z85.048 is referenced in 6 tracked payer policy changes from Blue Cross of Idaho, Blue Cross & Blue Shield of Mississippi, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z85.048 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross of Idaho · Identified Jun 19, 2026High impact
One-to-One for Healthcare - Winter Edition
For 2026, all Blue Cross of Idaho Medicare Advantage plans require members to choose a primary care provider, and specialty care, ancillary care and out-of-network services require a referral from that PCP, with the referral requirements detailed in MAPAP310. Referrals are good for the time span submitted by the PCP, with a maximum of 365 days, and a referral should be created for each specialty type and each condition being treated. Referrals and prior authorizations are separate processes, and the MA authorization process has not changed.
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 Nov 5, 2026Medium impact
High-Resolution Anoscopy (CPB 0808, reviewed 2026-10-29)
Aetna's Clinical Policy Bulletin 0808 (last reviewed 2026-10-29) restates when high-resolution anoscopy (HRA) is considered medically necessary: for diagnosing suspicious anal lesions in patients with abnormal anal findings and for guiding biopsy and ablation of high-grade anal intraepithelial neoplasia. HRA for screening asymptomatic persons, estimating treatment-failure risk after chemoradiotherapy, and routine surveillance after treated anal squamous cell carcinoma is listed as experimental/investigational/unproven. The source states no effective date for a new change; the listed effective date is 11/19/2010, and the next review is 09/09/2027.
Aetna · Identified Aug 17, 2026Medium impact
High-Resolution Anoscopy (CPB 0808, reviewed 2025-11-20)
Aetna considers high-resolution anoscopy (HRA) medically necessary to diagnose a suspicious anal lesion in persons with abnormal anal physical findings, and for HRA guidance for biopsy and ablation of high-grade anal intraepithelial neoplasia. Aetna considers HRA experimental, investigational, or unproven for screening asymptomatic persons for anal dysplasia and anal cancer, for estimating the risk of treatment failure of anal canal carcinoma after chemoradiotherapy, and for surveillance after treatment for anal squamous cell carcinoma. Current evidence is insufficient to establish routine HRA surveillance after treated anal squamous cell carcinoma as universally medically necessary.
Aetna · Identified Aug 12, 2026Medium impact
Cetuximab (Erbitux) (CPB 0684, reviewed 2025-12-03)
Aetna's commercial medical policy CPB 0684 covers cetuximab (Erbitux) for listed cancers when the member meets the criteria for that indication. Covered indications are colorectal cancer, head and neck cancer, non-small cell lung cancer, penile cancer and squamous cell skin cancer, each with its own conditions. Precertification is required. Aetna considers all other indications experimental, investigational or unproven.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z85.048?

There are 6 tracked policy changes affecting code Z85.048, including updates from Blue Cross of Idaho, Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z85.048?

Payers that have issued tracked updates for code Z85.048 include: Blue Cross of Idaho, Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna.

How do I get notified when code Z85.048 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z85.048. 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 Z85.048?

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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One-to-One for Healthcare - Winter Edition

Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes

Germline Genetic Testing for Hereditary Cancers 2.02.60

High-Resolution Anoscopy (CPB 0808, reviewed 2026-10-29)

High-Resolution Anoscopy (CPB 0808, reviewed 2025-11-20)

Cetuximab (Erbitux) (CPB 0684, reviewed 2025-12-03)

What insurance policy changes affect code Z85.048?

Which payers have updated policy for code Z85.048?

How do I get notified when code Z85.048 policy changes?

Why do payers change policies for code Z85.048?