Z95.1 Insurance Policy Changes

ICD-10 Z95.1 is officially defined as "Presence of aortocoronary bypass graft." code Z95.1 is referenced in 8 tracked payer policy changes from Aetna and Excellus BlueCross BlueShield. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z95.1 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 13, 2026High impact
Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 09-2025-10)
Aetna's commercial policy for Enflonsia (clesrovimab-cfor), CPB 1088, covers one intramuscular dose to prevent RSV lower respiratory disease in infants under 8 months entering their first RSV season, when the source's criteria are met. Those criteria turn on maternal RSV vaccine status and whether the infant has already received clesrovimab, nirsevimab or palivizumab, and commercial plans may require a trial of a lower-cost preferred drug first.
Excellus BlueCross BlueShield · Effective Oct 22, 2026Medium impact
Cardiac Rehabilitation 8.01.14
Excellus BlueCross BlueShield policy 8.01.14 covers monitored Phase I and Phase II cardiac rehabilitation (CR) for acute myocardial infarction, percutaneous coronary intervention, coronary bypass surgery, and heart transplantation within the preceding 12 months, and for Class II or higher congestive heart failure, stable angina pectoris, and valvular disease. Additional CR services are considered medically appropriate after another qualifying cardiac event, such as another documented MI, another cardiovascular surgery or percutaneous intervention, or new clinically significant coronary lesions documented by cardiac catheterization. Phase III maintenance programs are considered not medically necessary, and intensive cardiac rehabilitation programs, including the Ornish Program, the Pritikin Program and the Benson-Henry Institute Cardiac Wellness Program, are considered investigational for all indications. The 10/22/26 revision is an annual update, and the policy intent is unchanged.
Aetna · Effective Oct 9, 2025Medium impact
Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 2026-10-09)
Aetna considers a single intramuscular injection of clesrovimab-cfor (Enflonsia) medically necessary for preventing RSV lower respiratory tract disease in infants younger than 8 months who are born during or entering their first RSV season, when the selection criteria are met. Under those criteria, an infant qualifies when maternal RSV vaccine was not received or its status is unknown, when the infant was born less than 14 days after maternal vaccination, or when the maternal vaccine was received in a prior pregnancy, and the infant has not previously received clesrovimab-cfor, nirsevimab-alip, or palivizumab. The policy also states that an additional dose may be given as soon as an infant undergoing cardiac surgery with cardiopulmonary bypass during or entering the first RSV season is stable after surgery, and Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Sep 29, 2026Medium impact
Clesrovimab-cfor (Enflonsia) (CPB 1088)
Aetna Clinical Policy Bulletin 1088, Clesrovimab-cfor (Enflonsia), addresses this RSV antibody for commercial medical plans. It states Aetna considers the CDC ACIP recommendations for a single intramuscular injection medically necessary to prevent RSV lower respiratory tract disease when the listed infant criteria are met. The source text does not state an effective date or describe what changed.
Aetna · Identified Aug 16, 2026Medium impact
Nirsevimab-alip (Beyfortus) (CPB 1038, reviewed 2025-10-09)
Aetna's Clinical Policy Bulletin 1038 covers nirsevimab-alip (Beyfortus) for preventing lower respiratory tract disease caused by RSV. Aetna considers a single intramuscular injection medically necessary when the ACIP recommendations and the listed criteria are met, including for infants less than 8 months old born during or entering their first RSV season and for children 8 to 11 months old at increased risk for severe disease during their first RSV season. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (CPB 0491, reviewed 2026-07-30)
Aetna considers coronary artery brachytherapy medically necessary as adjunctive treatment during a second angioplasty or stent placement when blockage has re-occurred within the localized area of a previously placed stent (in-stent re-stenosis), in native coronary arteries or coronary artery bypass grafts. Aetna also considers intravascular shockwave lithotripsy (IVL) medically necessary for hemodynamically significant, heavily calcified coronary stenoses (for example, calcium extending over 270 degrees) where primary stenting is not possible. Coronary artery brachytherapy is considered experimental, investigational, or unproven for primary prevention of re-stenosis and all other indications outside those listed.
Aetna · Identified Aug 14, 2026Medium impact
Intensive Cardiac Rehabilitation Programs (CPB 0267, reviewed 2026-05-14)
Aetna considers intensive cardiac rehabilitation programs (the Benson-Henry Institute Cardiac Wellness Program, the Ornish cardiac treatment program and the Pritikin Program) medically necessary as an alternative to traditional Phase II cardiac rehabilitation for members who meet the cardiac rehabilitation criteria, limited to 72 one-hour sessions, up to 6 per day, over a period of up to 18 weeks. Virtual delivery by real-time audio and video (excluding audio-only) is considered medically necessary when the telehealth program and member criteria are met, but hospital outpatient departments are not eligible for virtual telehealth services. Intensive cardiac rehabilitation is considered experimental, investigational or unproven for diabetes, hyperlipidemia, prostate cancer, metabolic syndrome and all other indications where effectiveness has not been established.
Aetna · Identified Aug 14, 2026Medium impact
Thermography (CPB 0029, reviewed 2026-03-12)
Aetna considers thermography experimental, investigational, or unproven for all indications listed in the policy, including detection and screening for breast cancer, diagnosis of carpal tunnel syndrome, diagnosis of musculoskeletal injuries, and monitoring of diabetes mellitus. Aetna also considers dynamic infrared blood perfusion imaging (DIRI) for intra-operative and post-operative perfusion assessment experimental, investigational, or unproven. CPT 93740 (temperature gradient studies) is not covered for the indications listed.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z95.1?

There are 8 tracked policy changes affecting code Z95.1, including updates from Aetna, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z95.1?

Payers that have issued tracked updates for code Z95.1 include: Aetna, Excellus BlueCross BlueShield.

How do I get notified when code Z95.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z95.1. 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 Z95.1?

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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Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 09-2025-10)

Cardiac Rehabilitation 8.01.14

Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 2026-10-09)

Clesrovimab-cfor (Enflonsia) (CPB 1088)

Nirsevimab-alip (Beyfortus) (CPB 1038, reviewed 2025-10-09)

Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (CPB 0491, reviewed 2026-07-30)

Intensive Cardiac Rehabilitation Programs (CPB 0267, reviewed 2026-05-14)

Thermography (CPB 0029, reviewed 2026-03-12)

What insurance policy changes affect code Z95.1?

Which payers have updated policy for code Z95.1?

How do I get notified when code Z95.1 policy changes?

Why do payers change policies for code Z95.1?