Z85.828 Insurance Policy Changes

ICD-10 Z85.828 is officially defined as "Personal history of other malignant neoplasm of skin." code Z85.828 is referenced in 8 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z85.828 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Mar 30, 2026High impact
MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Independence Blue Cross updated policy MA11.099f effective 03/30/2026, removing the strict 4-week conservative medical trial and 75% nasal obstruction documentation requirements for septoplasty and rhinoplasty/septorhinoplasty. Septoplasty now requires only documentation of an attempted medical trial (not a specific 4-week duration), and rhinoplasty/septorhinoplasty criteria were expanded to include congenital deformities as a standalone criterion. Additionally, 16 ICD-10 codes were removed and 4 new codes were added per CMS LCD A56587 updates.
Independence Blue Cross · Effective Mar 30, 2026High impact
11.16.01m, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Independence Blue Cross removed the 75% nasal obstruction threshold requirement for septoplasty and rhinoplasty/septorhinoplasty, eliminating an objective measurement barrier. The policy now requires a 4-week medication trial and documented symptoms for vestibular stenosis treatment, adds cleft lip/palate and congenital craniofacial deformities as covered indications, removes multiple ICD-10 codes from coverage criteria, and classifies absorbable nasal implants (e.g., Latera) as experimental/investigational (not covered). These changes take effect March 30, 2026.
Independence Blue Cross · Effective Mar 30, 2026High impact
MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Independence Blue Cross MA11.099f has been reissued with significant coverage criteria changes for septoplasty, rhinoplasty, and septorhinoplasty. Key changes include: (1) Removal of the 4-week conservative medical trial and 75% nasal obstruction threshold requirements for septoplasty—now requiring only documentation of an attempted medical trial; (2) Addition of congenital deformities as a standalone coverage criterion for rhinoplasty/septorhinoplasty; (3) Removal of 15 ICD-10 diagnosis codes and addition of 4 new codes (C4A.31, C4A.39, Z85.820, Z85.821, Z85.828) effective 03/16/2026 per CMS LCA A56587 update. These changes reduce documentation burden and expand coverage eligibility.
Independence Blue Cross · Effective Mar 30, 2026High impact
11.16.01m, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Independence Blue Cross removed the 75% nasal obstruction threshold requirement for septoplasty and rhinoplasty/septorhinoplasty, added a new 4-week medication trial requirement for vestibular stenosis, expanded coverage for cleft lip/palate and congenital craniofacial deformities, removed multiple ICD-10 diagnosis codes from covered lists, and classified absorbable nasal implants (e.g., Latera) as experimental/investigational. Billing teams must update coverage criteria and remove outdated diagnosis codes from claims processing.
Aetna · Identified Aug 18, 2026Medium impact
Total Body Photography, Dermoscopy and Other Selected Noninvasive Dermatologic Tests (CPB 0188, reviewed 2026-08-04)
Aetna considers total body photography (TBP) and dermoscopy medically necessary when used to evaluate members with a history or close family history of atypical nevi, dysplastic nevi, melanoma, or non-melanoma skin cancers. Repeat studies are not typically required more frequently than every 24 months. CPT 96904 (whole body integumentary photography) is covered when the selection criteria are met, for monitoring high-risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or a personal or family history of melanoma. Computerized TBP systems, TBP and dermoscopy for all other indications, and several other noninvasive tests are listed as experimental, investigational or unproven, including reflectance confocal microscopy, electrical impedance devices, optical coherence tomography, and the DermTech Pigmented Lesion Assay.
Aetna · Identified Aug 16, 2026Medium impact
Eyelid Surgery (CPB 0084, reviewed 2026-03-03)
Upper lid blepharoplasty is medically necessary to correct prosthesis difficulties in an anophthalmia socket, to relieve painful blepharospasm, to treat peri-orbital sequelae of thyroid disease and nerve palsy, or to remove excess upper eyelid tissue causing functional visual impairment when photographs and visual field testing from the past 12 months meet the stated criteria. Upper lid ptosis repair and brow ptosis repair for functional visual impairment are medically necessary when their listed criteria are met, and ectropion and entropion repair are medically necessary to repair defects predisposing to corneal or conjunctival injury when selection criteria are met. Surgical correction of congenital ptosis is medically necessary to allow proper visual development in infants and children when the ptosis interferes with the field of vision and the child has abnormal head posture, amblyopia or strabismus, and congenital ptosis surgery is considered cosmetic when performed for mild ptosis that is only of cosmetic concern.
Aetna · Identified Aug 12, 2026Medium impact
Beremagene Geperpavec-svdt (Vyjuvek) (CPB 1033, reviewed 2026-06-12)
Aetna's clinical policy for Vyjuvek (beremagene geperpavec-svdt) applies to commercial medical plans, where Aetna's GCIT team gives it dedicated review, and precertification is required for all Aetna participating providers and members in applicable plan designs. Vyjuvek is medically necessary for treating open wounds in members with dystrophic epidermolysis bullosa (DEB) who have a confirmed pathogenic or likely pathogenic COL7A1 variant, when the target wounds meet the listed wound criteria and the member has not had a skin graft in the past three months. Aetna considers all other indications experimental, investigational, or unproven, and the maximum weekly dose is 2 x 10^9 PFU for patients under 3 years old and 4 x 10^9 PFU for patients 3 years and older.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Removal of Benign Skin Lesions and Scars
Cosmetic surgery and any complications of cosmetic surgery are not eligible for coverage, including any operative procedure or portion of one intended solely to improve physical appearance. Removal of seborrheic keratoses, sebaceous (epidermoid) cysts, nevi, papillomas and viral warts (excluding condyloma acuminatum) is medically necessary only when the lesion is symptomatic or has objective signs or symptoms listed in the policy, such as itching, burning, irritation, significant change in color or size or bleeding, physical evidence of inflammation, obstruction of an orifice or clinically restricted vision, clinical uncertainty about malignancy, a prior biopsy indicative of malignancy, or recurrent physical trauma that is documented to have occurred. Removal for reasons such as emotional distress, "makeup trapping" or location alone is considered cosmetic and not medically necessary.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z85.828?

There are 8 tracked policy changes affecting code Z85.828, including updates from Independence Blue Cross, Aetna, 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 Z85.828?

Payers that have issued tracked updates for code Z85.828 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code Z85.828 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z85.828. 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 Z85.828?

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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MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty

11.16.01m, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty

MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty

11.16.01m, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty

Total Body Photography, Dermoscopy and Other Selected Noninvasive Dermatologic Tests (CPB 0188, reviewed 2026-08-04)

Eyelid Surgery (CPB 0084, reviewed 2026-03-03)

Beremagene Geperpavec-svdt (Vyjuvek) (CPB 1033, reviewed 2026-06-12)

Removal of Benign Skin Lesions and Scars

What insurance policy changes affect code Z85.828?

Which payers have updated policy for code Z85.828?

How do I get notified when code Z85.828 policy changes?

Why do payers change policies for code Z85.828?