Z87.890 Insurance Policy Changes

ICD-10 Z87.890 is officially defined as "Personal history of sex reassignment." code Z87.890 is referenced in 20 tracked payer policy changes from UnitedHealthcare, Blue Cross & Blue Shield of Mississippi, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z87.890 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

UnitedHealthcare · Effective Oct 1, 2026High impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (UMR)
UnitedHealthcare's UMR medical policy update bulletin for October 2026 says the annual ICD-10 and quarterly CPT/HCPCS code changes took effect October 1, 2026 across its medical and drug policies. The billing team needs to add the new CPT, HCPCS and ICD-10 codes to charge entry, stop using the codes that were removed, and update the revised descriptions. The bulletin lists the code changes but does not state any coverage decisions beyond the policies it updates, so the practice should check each updated policy before billing the new codes.
UnitedHealthcare · Effective Oct 1, 2026High impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Surest)
UnitedHealthcare's Surest medical policy update bulletin for October 2026 says the annual ICD-10 and quarterly CPT/HCPCS code changes took effect October 1, 2026 across its medical and drug policies. The billing team needs to add the new CPT, HCPCS and ICD-10 codes to charge entry, stop using the codes that were removed, and update the revised descriptions. The bulletin lists the code changes but does not state any coverage decisions beyond the policies it updates, so the practice should check each updated policy before billing the new codes.
UnitedHealthcare · Effective Oct 1, 2026High impact
Gender Dysphoria and Gender Reassignment Surgery
UnitedHealthcare Medicare Advantage updated ICD-10 diagnosis codes for Gender Dysphoria and Gender Reassignment Surgery, replacing the general code Z87.890 (deleted September 30, 2026) with five more specific codes: Z87.8901, Z87.8902, Z87.8903, Z87.8904, and Z87.8909. Billing teams must immediately update their systems to use only the new specific codes and discontinue use of the deleted code to avoid claim denials.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026High impact
Gender Dysphoria Treatment in Adults
The Code Reference section was updated effective October 1, 2026 to add personal history diagnosis codes Z87.8901 (social gender transition), Z87.8902 (medical gender transition), Z87.8903 (surgical gender transition), Z87.8904 (intersex surgery), Z87.8909 (unspecified gender transition) and Z87.893 (gender detransition). Code Z87.890 (personal history of sex reassignment) was deleted 09/30/2026. Feminizing or masculinizing hormone therapy is considered medically necessary for adults 18 and older with a documented referral from a qualified mental health professional and the other listed criteria, and gender reassignment surgery requires prior approval and is considered medically necessary only when all listed criteria are met.
UnitedHealthcare · Effective Nov 1, 2026Medium impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid, NM)
Effective Nov. 1, 2026, UnitedHealthcare Community Plan of New Mexico (Medicaid) updated several medical policies to reflect annual ICD-10 and quarterly CPT/HCPCS additions and deletions. Billing teams should update charge entry and claim edits so claims for the added codes go out correctly and claims using the removed codes are no longer submitted for these members, referring to the CPT, HCPCS and ICD-10 sources cited in the bulletin for code descriptions.
UnitedHealthcare · Effective Nov 1, 2026Medium impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid, NJ)
UnitedHealthcare Community Plan of New Jersey (Medicaid) updated its medical policies effective November 1, 2026 to reflect annual ICD-10 and quarterly CPT/HCPCS code additions and deletions across several New Jersey-only policies, including autologous cellular therapy, cell-free fetal DNA testing, electrical stimulation, gender dysphoria treatment, hereditary cancer genetic testing, lower extremity endovascular procedures, molecular oncology testing, sleep apnea treatment, and respiratory pathogen testing. Billing staff should update charge master and claim-entry code lists so that added codes are available and deleted codes are removed for New Jersey Medicaid members' claims.
UnitedHealthcare · Effective Nov 1, 2026Medium impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid, KS)
UnitedHealthcare Community Plan of Kansas (Medicaid) updated several Kansas medical policies effective November 1, 2026 to reflect annual ICD-10 and quarterly CPT/HCPCS code additions and deletions. Affected policies cover autologous cellular therapy, cell-free fetal DNA testing, electrical stimulation for pain and muscle rehabilitation, gender dysphoria treatment, hereditary cancer genetic testing, molecular oncology testing for solid tumors, sleep apnea treatment, and respiratory pathogen testing. Billing teams should update charge entry and claim code sets for the added and removed codes so claims for Kansas Medicaid members use the current codes.
UnitedHealthcare · Effective Nov 1, 2026Medium impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid)
UnitedHealthcare's Community Plan Medicaid medical policies were updated effective November 1, 2026 to reflect annual ICD-10 and quarterly CPT/HCPCS code additions and deletions across autologous cellular therapy, cell-free fetal DNA testing, electrical stimulation for pain and muscle rehabilitation, gender dysphoria treatment, hereditary cancer genetic testing, lower extremity endovascular procedures, molecular oncology testing, sleep apnea treatment, and respiratory pathogen testing. Billing teams should update charge master entries, diagnosis code lists, and claim edits so that newly added codes are used and deleted codes are no longer submitted for Medicaid members.
UnitedHealthcare · Effective Oct 1, 2026Medium impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Exchange)
Effective October 1, 2026, UnitedHealthcare updated several Individual Exchange medical policies to match the annual ICD-10 and quarterly CPT/HCPCS code changes. The bulletin adds many new codes across areas such as cardiology, pregnancy, hematology, genetic testing and pain or rehabilitation, and it removes a smaller set of older codes.
UnitedHealthcare · Effective Oct 1, 2026Medium impact
Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Commercial)
UnitedHealthcare's Commercial medical and drug policies were updated effective October 1, 2026 to match the annual ICD-10 and quarterly CPT/HCPCS code changes. Codes were added, revised or removed across topics including genetic testing, molecular oncology, cell therapy, pregnancy preventive care, sudden cardiac arrest risk and Category III codes, so the billing team needs to update its code lists and charge entry tables to match.
Independence Blue Cross · Effective Oct 1, 2026Medium impact
00.06.02ba, Preventive Care Services
Independence Blue Cross updated ICD-10 coding for preventive behavioral counseling services related to sexually transmitted infection prevention, effective 10/01/2026. Six new gender transition and intersex surgery history codes (Z87.8901-Z87.8904, Z87.8909, Z87.893) replace the terminated code Z87.890. Billing teams must update claims processing and coding references to use the new codes for claims dated on or after the effective date.
Excellus BlueCross BlueShield · Effective Aug 20, 2026Medium impact
Gender Affirming Behavioral Health and Medical Services 3.01.22
Already effective August 20, 2026: The annual review left the policy intent unchanged. Behavioral health services, such as assessment, counseling and psychotherapy, for a diagnosis of gender dysphoria are considered medically appropriate for individuals of all ages. All gender- and age-specific services that are otherwise medically necessary are also considered medically necessary for individuals diagnosed with gender dysphoria, including comprehensive primary care, reproductive care, and gynecological or urological cancer screening before, during and ongoing after gender affirming treatments.
Excellus BlueCross BlueShield · Effective May 21, 2026Medium impact
Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members 7.01.84
Policy 7.01.84 sets the criteria for gender affirming surgery and treatments for commercial and Medicare Advantage members, with a current effective date of May 21, 2026. Gender affirming surgery may be considered medically necessary when the member has reached age 18 (except for mastectomy), one letter from a qualified professional documents gender dysphoria that is marked and sustained for at least 6 months, and the other general criteria are met. Breast augmentation, hysterectomy, gonadectomy and genital reconstructive surgery each require six months of continuous hormone therapy or a documented contraindication to hormone therapy, and voice modification and voice therapy require review by a Health Plan Behavioral Health Medical Director.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Endometrial Ablation 4.01.01
The 02/19/26 annual review of Excellus policy 4.01.01 Endometrial Ablation replaced the policy statement on using endometrial ablation for gender dysphoria with a reference to Corporate Medical Policy 3.01.22 Gender Affirming Behavioral Health and Medical Services. The policy considers endometrial ablation medically appropriate only when all listed criteria are met, including menorrhagia for more than three menstrual cycles, failure of or a contraindication to hormone therapy over three consecutive cycles, symptoms that interfere with activities of daily living or anemia unresponsive to treatment, a normal Pap smear within the past 12 months, a normal endometrium within the last six to 12 months, no pregnancy or desire for future pregnancy, and FDA approval of the device. Listed contraindications include known or suspected endometrial carcinoma, an enlarged uterus greater than 10 cm in length, submucosal myomas, active genital or urinary tract infection, and an intrauterine device in place.
Nevada Medicaid · Effective Dec 29, 2025Medium impact
Prior Authorization Requirements Updated for Gender Dysphoria Services
Nevada Medicaid now requires prior authorization for specific gender dysphoria surgical procedures when billed with certain diagnosis codes (F64.0, F64.1, F64.2, F64.8, F64.9, or Z87.890). Six specific procedure codes are affected, and modifier KX or condition code 45 is still required for transgender patient claims.
Kansas Medicaid (KanCare) · Effective Sep 1, 2025Medium impact
KMAP BULLETIN: No Medicaid Coverage for Surgical/Pharmacologic (Hormonal) Gender Affirming Care – Adults (21 and Older)
Kansas Medicaid will no longer cover new surgical or hormonal gender affirming care for adults 21 and older starting September 1, 2025. Claims with gender dysphoria diagnosis codes will automatically suspend for manual review to check for grandfathered exceptions.
Aetna · Identified Oct 18, 2026Medium impact
Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-10-14)
Aetna considers gonadotropin-releasing hormone (GnRH) analogs and antagonists medically necessary for commercial plan members only for the specific indications listed for each drug, including leuprolide, goserelin, histrelin, triptorelin, degarelix, cetrorelix and ganirelix, and treats all other indications as experimental, investigational or unproven. Each drug has separate criteria for initial approval and for continuation of therapy, and continuation for prostate cancer requires clinical benefit such as serum testosterone less than 50 ng/dL and no unacceptable toxicity. Precertification is required for the prostate cancer indication, and gender dysphoria treatment for members under 18 must be prescribed by or in consultation with a provider specialized in the care of transgender youth who has collaborated care with a mental health provider.
Aetna · Identified Aug 15, 2026Medium impact
Implantable Hormone Pellets (CPB 0345, reviewed 2026-07-08)
Reviewed 2026-07-08, Aetna Clinical Policy Bulletin 0345 covers implantable hormone pellets for commercial medical plans. Estradiol pellets are considered experimental, investigational, or unproven because they produce unpredictable and fluctuating serum estrogen concentrations. Testosterone propionate implant pellets (Testopel) are considered medically necessary for delayed male puberty, for gender dysphoria under the listed criteria, and for primary or hypogonadotropic hypogonadism when at least two confirmed low morning testosterone levels are documented before therapy starts. Age-related hypogonadism is an exclusion for testosterone implant pellets. Progestin and progesterone pellets are considered experimental for dysmenorrhea and erythema nodosum.
Aetna · Identified Aug 15, 2026Medium impact
Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-07-10)
Aetna covers gonadotropin-releasing hormone (GnRH) analogs and antagonists under its commercial medical plans for the indications the policy lists, including prostate cancer, breast cancer, ovarian cancer, central precocious puberty, endometriosis, uterine leiomyomata (fibroids), and ovulation induction or assisted reproductive technology. The policy also sets criteria for gender dysphoria treatment, including pubertal suppression in adolescents and gender transition, and for continuation of therapy. Aetna considers all other indications experimental, investigational, or unproven.
Excellus BlueCross BlueShield · Effective Jan 22, 2026Low impact
Gender Reassignment/Gender Affirming Surgery and Treatments for Medicaid Managed Care Plan (MMCP) and Health and Recovery Plan (HARP) Members 7.01.105
Effective January 22, 2026, gender reassignment surgery is considered medically appropriate for members age 18 or older who have referral letters from two qualified NYS licensed health professionals, and the policy lists the covered surgeries and services for Medicaid Managed Care Plan and Health and Recovery Plan members. The January 22, 2026 annual review moved the hormone therapy criteria to Pharmacy policies with policy intent unchanged, and a March 20, 2026 policy edit revised policy statement references for alignment, also with intent unchanged.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z87.890?

There are 20 tracked policy changes affecting code Z87.890, including updates from UnitedHealthcare, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z87.890?

Payers that have issued tracked updates for code Z87.890 include: UnitedHealthcare, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross, Excellus BlueCross BlueShield, Nevada Medicaid, Kansas Medicaid (KanCare), Aetna.

How do I get notified when code Z87.890 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z87.890. 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 Z87.890?

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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Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (UMR)

Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Surest)

Gender Dysphoria and Gender Reassignment Surgery

Gender Dysphoria Treatment in Adults

Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid, NM)

Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid, NJ)

Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid, KS)

Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Medicaid)

Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Exchange)

Annual ICD-10 and Quarterly CPT/HCPCS Code Updates (Commercial)

00.06.02ba, Preventive Care Services

Gender Affirming Behavioral Health and Medical Services 3.01.22

Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members 7.01.84

Endometrial Ablation 4.01.01

Prior Authorization Requirements Updated for Gender Dysphoria Services

KMAP BULLETIN: No Medicaid Coverage for Surgical/Pharmacologic (Hormonal) Gender Affirming Care – Adults (21 and Older)

Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-10-14)

Implantable Hormone Pellets (CPB 0345, reviewed 2026-07-08)

Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-07-10)

Gender Reassignment/Gender Affirming Surgery and Treatments for Medicaid Managed Care Plan (MMCP) and Health and Recovery Plan (HARP) Members 7.01.105

What insurance policy changes affect code Z87.890?

Which payers have updated policy for code Z87.890?

How do I get notified when code Z87.890 policy changes?

Why do payers change policies for code Z87.890?