Z85.4A Insurance Policy Changes

ICD-10 Z85.4A is officially defined as "Personal history of malignant neoplasm of fallopian tube(s)." code Z85.4A is referenced in 8 tracked payer policy changes from Medicare/CMS - Transmittals, Capital Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z85.4A is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medicare/CMS - Transmittals · Effective Jul 6, 2026High impact
R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197
CMS updated Chapters 3, 13, 17, 18 and 32 of the Medicare Claims Processing Manual to match National Coverage Determination updates for ICD-10 and other coding revisions. The updated sections are effective July 6, 2026. Several code changes apply to services on or after October 1, 2025, including new ICD-10 diagnosis codes for mammography, Pap smears, PET, colorectal cancer screening and chronic ulcer wound treatment, and coverage for HCPCS codes J0738 and J0752 for PrEP.
Capital Blue Cross · Effective Mar 1, 2026High impact
AB2026-01-001 Updates and new information
Effective March 1, 2026, a number of codes newly require preauthorization for Commercial and Medicare Advantage members, including 20985, 22100 and 27860, and HCPCS code H0032 will be denied because the service is not provided directly to members. Codes C1605, C1721 and others no longer require preauthorization effective February 1, 2026, Evolent updated its CT, MRI, PET and cardiac imaging policies effective March 1, 2026, and TurningPoint accepts listed substitute codes for a limited group of musculoskeletal surgical procedures effective February 1, 2026. Effective for claims processed on or after March 1, 2026, facility claims with modifiers 59, XE, XP, XS and XU that do not meet the CMS criteria to bypass an NCCI procedure-to-procedure edit will be rejected, and physical medicine code 97140 is not separately reimbursed when billed with chiropractic manipulative treatment in the same anatomical region.
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.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross updated MA11.077i to MA11.077j, adding nine new ICD-10 diagnosis codes effective 10/01/2025 to support coding for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures. The policy itself was reissued on 04/01/2026 to reaffirm the Company's continuing coverage position; no changes to medical necessity criteria or procedure coverage occurred.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross updated MA11.077i to MA11.077j, adding nine new ICD-10 diagnosis codes (effective 10/01/2025) related to inflammatory breast cancer, fallopian tube conditions, and prophylactic surgery encounters. The policy reissued on 04/01/2026 to reaffirm the Company's continuing position on prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy coverage criteria without substantive changes to medical necessity standards.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
00.06.02aw, Preventive Care Services
Independence Blue Cross updated preventive care policy 00.06.02aw to 00.06.02ba, effective 10/01/2025, making targeted HCPCS and ICD-10 code updates. Key changes include: adding HCPCS J0525 for colorectal cancer screening services (replacing S0074), adding HCPCS A4288 for breastfeeding supplies, clarifying J7300 intrauterine contraceptive description, and adding new ICD-10 codes for financial insecurity counseling and BRCA genetic testing. Billing teams must update systems to recognize the new/replaced codes and ensure proper claim adjudication at $0 cost-share for qualifying preventive services.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross has reissued policy 11.08.19s (now version 11.08.19t) for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy with updated ICD-10 codes effective 10/01/2025. Nine new diagnosis codes have been added to support coverage determinations, including codes for inflammatory breast cancer, genetic susceptibility to fallopian tube malignancy, and family/personal history of fallopian tube cancer. The coverage criteria and medical necessity standards remain unchanged from the prior version.
Independence Blue Cross · Effective Oct 1, 2025Low impact
11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross reissued policy 11.08.19s on 04/01/2026 to reaffirm coverage for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy in high-risk and moderately increased-risk individuals. Nine new ICD-10 diagnosis codes were added effective 10/01/2025 to support claims related to inflammatory breast cancer, genetic susceptibility to fallopian tube malignancies, and family/personal history of fallopian tube neoplasms. No changes to coverage criteria, CPT codes, or billing requirements were made.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z85.4A?

There are 8 tracked policy changes affecting code Z85.4A, including updates from Medicare/CMS - Transmittals, Capital Blue Cross, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z85.4A?

Payers that have issued tracked updates for code Z85.4A include: Medicare/CMS - Transmittals, Capital Blue Cross, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when code Z85.4A policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z85.4A. 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 Z85.4A?

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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R13809CP: Update to the Internet Only Manual (IOM) Publication 100-04, Chapters 3, 13, 17, 18 and 32 for Coding Revisions to National Coverage Determination (NCDs) - January 2026 Change Requests (CRs) 14194 and 14197

AB2026-01-001 Updates and new information

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

MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy