Z95.812 Insurance Policy Changes

ICD-10 Z95.812 is officially defined as "Presence of fully implantable artificial heart." code Z95.812 is referenced in 3 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z95.812 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 · 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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Home Prothrombin Time Monitoring
At-home prothrombin time (INR) monitoring of chronic warfarin therapy may be considered medically necessary for patients who require continuous anticoagulation for chronic medical conditions, including patients with mechanical heart valves and chronic atrial fibrillation. Before at-home monitoring starts, patients must have undergone anticoagulation management for at least 3 months. The policy history records a 05/04/2026 update that removed ICD-9 diagnosis codes from the Code Reference section and added ICD-10 diagnosis codes Z95.811, Z95.812 and Z95.818. The covered procedure codes are CPT 93792 and HCPCS E1399, G0248, G0249 and G0250.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z95.812?

There are 3 tracked policy changes affecting code Z95.812, including updates from Excellus BlueCross BlueShield, 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 Z95.812?

Payers that have issued tracked updates for code Z95.812 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code Z95.812 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z95.812. 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 Z95.812?

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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Cardiac Rehabilitation 8.01.14

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

Home Prothrombin Time Monitoring

What insurance policy changes affect code Z95.812?

Which payers have updated policy for code Z95.812?

How do I get notified when code Z95.812 policy changes?

Why do payers change policies for code Z95.812?