Z92.3 Insurance Policy Changes

ICD-10 Z92.3 is officially defined as "Personal history of irradiation." code Z92.3 is referenced in 15 tracked payer policy changes from Capital Blue Cross, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z92.3 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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.
Excellus BlueCross BlueShield · Effective Aug 20, 2026Medium impact
Focal Therapies for Prostate Cancer Treatment 7.01.01
Cryosurgery and high-intensity focused ultrasound (HIFU) for recurrent prostate cancer are medically appropriate when prostate cancer has recurred after radiation therapy, as shown by a positive repeat biopsy, and there is no metastatic disease. Cryotherapy or other focal therapies, including HIFU, used for routine primary therapy for localized prostate cancer are considered investigational, as are vascular-targeted photodynamic therapy, irreversible electroporation, NanoKnife tissue ablation, laser interstitial thermal therapy, transurethral ultrasound ablation, NanoTherm magnetic field induction, and high energy water vapor thermotherapy for routine treatment. The 08/20/26 annual review kept the policy intent unchanged, and the current effective date is August 20, 2026.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
MA07.036e, Low-Level Laser Therapy
Independence Blue Cross Medicare Advantage has added CPT code 1011T (Photobiomodulation therapy of oral cavity) as a medically necessary code effective 01/01/2026 for low-level laser therapy used to prevent oral mucositis in cancer patients undergoing chemotherapy, radiotherapy, or stem cell transplantation. Billing teams must implement this new code in their systems and ensure proper documentation of eligible diagnoses to avoid claim denials.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
07.00.14i, Low-Level Laser Therapy
Independence Blue Cross added CPT code 1011T (Photobiomodulation therapy of oral cavity) effective January 1, 2026, as a medically necessary procedure for prevention of oral mucositis in cancer patients undergoing chemotherapy, radiotherapy, or hematopoietic stem cell transplantation. All other LLLT applications remain experimental/investigational and non-covered. Billing teams must ensure claims use the correct code and include required ICD-10 diagnosis codes to avoid denials and audit exposure.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Human Growth Hormone and Insulin-like Growth Factor-1
Already effective 2025-10-01: Prior authorization is required for the growth hormone products listed in this policy, and the policy criteria were extensively revised. Use of samples by an individual will not be considered current or stable therapy to satisfy policy requirements. Egrifta SV and Egrifta WR are considered not medically necessary because the reduction of excess abdominal fat is considered cosmetic, and Genotropin, Humatrope, Ngenla, Omnitrope, Skytrofa, Sogroya and Zomacton are considered not medically necessary because other formulary alternatives are covered by the plan.
Aetna · Identified Oct 7, 2026Medium impact
Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)
Aetna considers measurement of plasma brain natriuretic peptide (BNP) medically necessary to differentiate dyspnea due to heart failure from pulmonary disease, to determine prognosis or severity in chronic heart failure, to screen for heart failure annually in adults with diabetes mellitus, to measure upon hospital admission and before discharge in acutely decompensated heart failure, for preoperative cardiac risk assessment before elevated-risk noncardiac surgery in members with known cardiovascular disease, age 65 or older, or age 45 or older with cardiovascular symptoms, and as an adjunct test for risk stratification of Stage C aortic stenosis. Serial BNP and NT-proBNP measurements and the other uses listed in the policy, such as diagnosing Kawasaki disease, are considered experimental, investigational, or unproven. CPT 83880 is covered when the selection criteria are met, except as a cardiovascular biomarker in healthy normal subjects and for identifying stress-induced myocardial ischemia.
Aetna · Identified Oct 5, 2026Medium impact
Mammography (CPB 0584, reviewed 2026-09-10)
Annual screening mammography is medically necessary for women aged 40 and older as a preventive service, and for women under 40 who are judged to be at high risk, such as BRCA1 or BRCA2 mutation carriers. Diagnostic mammography is covered for members with signs or symptoms of breast disease or a history of breast cancer, whether or not they have preventive benefits. AI-based mammography, contrast-enhanced mammography for members who do not meet the medical necessity criteria, and screening mammography in men outside the listed indications are considered experimental, investigational or unproven.
Aetna · Identified Aug 19, 2026Medium impact
Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)
Aetna considers breast MRI medically necessary for members who had a recent (within the past year) conventional mammogram and/or breast sonogram, when MRI may affect clinical management. Covered circumstances include detecting local tumor recurrence after mastectomy and breast reconstruction with an implant, assessing residual cancer after an incomplete lumpectomy, and adjunct screening to mammography for women at high genetic risk or with a lifetime breast cancer risk of 20 to 25 percent or more. Breast MRI is considered experimental, investigational or unproven for listed uses such as screening women with average breast cancer risk, evaluating BI-RADS 4 or 5 lesions found on mammogram or ultrasound, and screening women with dense breasts who are asymptomatic and have no additional risk factors. Computer-aided detection is considered integral to breast MRI and is not separately reimbursed.
Aetna · Identified Aug 19, 2026Medium impact
Xerostomia: Selected Treatments (CPB 0302, reviewed 2026-04-14)
Aetna considers electrical stimulation devices, including the Salitron System and the Saliwell Crown, experimental, investigational, or unproven for the prevention or treatment of xerostomia (dry mouth) or for any other indication. The bulletin also lists acupuncture, acupuncture-like transcutaneous electrical nerve stimulation (ALTENS), adipose tissue-derived mesenchymal stem cell therapy, fat grafting to salivary glands, hyperbaric oxygen, low-level laser or light therapy, transcutaneous electrical nerve stimulation (TENS), and Venalot Depot as experimental, investigational, or unproven for treating xerostomia. Several CPT and HCPCS codes are listed as not covered for the indications in the bulletin.
Aetna · Identified Aug 18, 2026Medium impact
Mammography (CPB 0584, reviewed 2025-09-09)
Aetna considers annual screening mammography medically necessary as a preventive service for women aged 40 and older, and for women under 40 who are judged to be at high risk, such as BRCA1 or BRCA2 mutation carriers and women meeting the other listed risk criteria. Diagnostic mammography is covered for members with signs or symptoms of breast disease or a history of breast cancer, regardless of whether the member has preventive benefits. Digital mammography and digital breast tomosynthesis are acceptable alternatives to film and standard 2D mammography, computer-aided detection is a medically necessary adjunct, and contrast-enhanced mammography is covered only for high-risk members who meet breast MRI criteria but have a documented contraindication, intolerance, or lack of access.
Aetna · Identified Aug 16, 2026Medium impact
Fibroid Treatment (CPB 0304, reviewed 2026-04-17)
Aetna considers radiofrequency ablation or transcatheter uterine artery embolization medically necessary as an alternative to hysterectomy or myomectomy for uterine fibroids when the member has persistent symptoms directly attributed to the fibroids, such as excessive menstrual bleeding, bulk-related pelvic pain, pressure or discomfort, urinary symptoms from compression of the ureter or bladder, or dyspareunia. Aetna considers myomectomy or hysterectomy using power morcellation experimental, investigational, or unproven, except in women without known or strongly suspected uterine cancer who meet the listed exception criteria, such as premenopausal women who wish to maintain fertility and have no risk factors for uterine sarcoma. Aetna also considers cryomyolysis, cryotherapy, electrical ablation, interstitial thermotherapy, laparoscopic uterine artery occlusion, lasers, focused ultrasound ablation, acupuncture, and other uses of transcatheter uterine artery embolization experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-01-27)
Aetna considers measurement of plasma BNP medically necessary to differentiate dyspnea due to heart failure from pulmonary disease, to determine prognosis or disease severity in chronic heart failure, to screen adults with diabetes annually for heart failure, to measure on hospital admission for prognosis in acutely decompensated heart failure, to measure before hospital discharge to inform postdischarge prognosis, to assess preoperative cardiac risk for elevated-risk noncardiac surgery in members with known cardiovascular disease, age 65 or older, or age 45 or older with CVD symptoms, and as an adjunct test for risk stratification of individuals with severe (Stage C) aortic stenosis. Serial measurements of plasma BNP or NT-proBNP are considered experimental, investigational or unproven for all other indications, including monitoring or titrating therapy in chronic heart failure, routine evaluation of dyspnea other than to distinguish heart failure from pulmonary disease, and screening for unrecognized left ventricular dysfunction. CPT 83880 is covered when selection criteria are met, except as a cardiovascular biomarker in healthy normal subjects and for identifying stress-induced myocardial ischemia.
Aetna · Identified Aug 14, 2026Medium impact
Jaw Motion Rehabilitation Systems (CPB 0412, reviewed 2026-06-30)
Aetna considers jaw motion rehabilitation systems, such as the Therabite Jaw Motion Rehabilitation System and the OraStretch press, medically necessary to treat mandibular hypomobility caused by radiation in persons with head and neck cancers. These systems are considered experimental, investigational, or unproven for all other indications, including trismus, closed lock, orofacial pain, non-surgical temporomandibular joint dysfunction, stroke, and Treacher Collins syndrome. Some plans exclude coverage of jaw stretch devices as equipment available over the counter without a prescription.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Extracranial Carotid Artery Stenting
Carotid angioplasty with an FDA-approved carotid stent and an FDA-approved or cleared embolic protection device may be considered medically necessary for individuals with 50% to 99% stenosis (NASCET measurement), symptoms of focal cerebral ischemia (transient ischemic attack or monocular blindness) in the previous 120 days, symptom duration under 24 hours or non-disabling stroke, and an anatomic contraindication to carotid endarterectomy. Carotid angioplasty with stenting and embolic protection is investigational for other indications, including suitable carotid endarterectomy candidates and carotid artery dissection, and carotid angioplasty without stenting and embolic protection is investigational for all indications. Transcarotid artery revascularization is investigational for all indications. The 05/28/2026 revision also removed the ICD-9 procedure and diagnosis codes from the code reference.
Independence Blue Cross · Identified Jun 19, 2026Medium impact
MA07.036d, Low-Level Laser Therapy
Independence Blue Cross Medicare Advantage has reissued policy MA07.036d on Low-Level Laser Therapy, clarifying that LLLT is covered only for prevention of oral mucositis in cancer patients undergoing chemotherapy, radiotherapy, or stem cell transplantation. All other LLLT uses remain experimental/investigational and non-covered. CPT code 97037 was added to the experimental category as of 01/02/2024. Billing teams must ensure claims use only approved codes (1011T for covered oral mucositis cases) and avoid misrepresenting LLLT services with incorrect codes like 97026.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z92.3?

There are 15 tracked policy changes affecting code Z92.3, including updates from Capital Blue Cross, Excellus BlueCross BlueShield, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z92.3?

Payers that have issued tracked updates for code Z92.3 include: Capital Blue Cross, Excellus BlueCross BlueShield, Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code Z92.3 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z92.3. 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 Z92.3?

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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AB2026-01-001 Updates and new information

Focal Therapies for Prostate Cancer Treatment 7.01.01

MA07.036e, Low-Level Laser Therapy

07.00.14i, ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy

Human Growth Hormone and Insulin-like Growth Factor-1

Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)

Mammography (CPB 0584, reviewed 2026-09-10)

Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)

Xerostomia: Selected Treatments (CPB 0302, reviewed 2026-04-14)

Mammography (CPB 0584, reviewed 2025-09-09)

Fibroid Treatment (CPB 0304, reviewed 2026-04-17)

Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-01-27)

Jaw Motion Rehabilitation Systems (CPB 0412, reviewed 2026-06-30)

Extracranial Carotid Artery Stenting

MA07.036d, Low-Level Laser Therapy

What insurance policy changes affect code Z92.3?

Which payers have updated policy for code Z92.3?

How do I get notified when code Z92.3 policy changes?

Why do payers change policies for code Z92.3?

07.00.14i, Low-Level Laser Therapy