What insurance policy changes affect HCPCS C9364?

There are 7 tracked policy changes affecting HCPCS C9364, including updates from Independence Blue Cross, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS C9364?

Payers that have issued tracked updates for HCPCS C9364 include: Independence Blue Cross, Humana.

How do I get notified when HCPCS C9364 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS C9364. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS C9364?

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.

C9364 Insurance Policy Changes

HCPCS C9364 is officially defined as "Porcine implant, permacol, per square centimeter." HCPCS C9364 is referenced in 7 tracked payer policy changes from Independence Blue Cross and Humana. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9364 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact
MA11.030j, Reconstructive Breast Surgery
Independence Blue Cross·Effective Dec 8, 2026
Independence Blue Cross Medicare Advantage is revising coverage for acellular dermal matrices (ADM) in reconstructive breast surgery effective 12/08/2026. Eight HCPCS codes are being removed from this policy and reclassified as experimental/investigational or moved to the Bioengineered Skin Substitutes policy (MA11.015). Additionally, Q4130 (Strattice) and Q4433 (361 hct/p skin substitute) are changing from medically necessary to experimental/investigational status. Billing teams must stop using these codes for reconstructive breast surgery claims and verify coverage under the new policy before claim submission.
High impact
Skin and Tissue Substitutes - MEDICAID - INDIANA (New)
Humana·Effective May 20, 2026
Humana Indiana Medicaid has established new coverage criteria for skin and tissue substitutes (cellular and acellular matrices) effective May 20, 2026. Coverage is limited to two indications: partial- and full-thickness diabetic foot ulcers (DFU) and chronic venous leg ulcers (VLU), both >4 weeks duration, when used with standard wound therapy and meeting specific clinical prerequisites. All other indications are not covered. This is a historical material discovery—the policy became effective over 4 months prior to analysis date (2026-10-15).
High impact
MA11.030i, Reconstructive Breast Surgery
Independence Blue Cross·Effective Jan 1, 2026
Independence Blue Cross updated CPT/HCPCS coding descriptors and terminology for reconstructive breast surgery materials effective 01/01/2026. Key changes include: Q4130 (Strattice) and Q4116 (AlloDerm) now specified as add-on codes with updated descriptors; Q4100 (generic skin substitute) terminated and replaced by Q4433; and C5271/C5272 (low-cost skin substitute application codes) removed from coverage. Billing teams must update systems to reflect new code terminology and add-on designations to avoid claim denials.
High impact
11.08.15ad, Reconstructive Breast Surgery and Post-Mastectomy Prostheses
Independence Blue Cross·Effective Jan 1, 2026
Independence Blue Cross has updated policy 11.08.15ad to 11.08.15ae with CPT/HCPCS code revisions effective 01/01/2026. Two HCPCS codes (Q4130, Q4116) have been reformatted to reflect add-on code status with updated descriptions, one NOC code (Q4100) has been terminated and replaced by Q4433, and two C-codes (C5271, C5272) for low-cost skin substitutes have been removed from coverage. Billing teams must update their systems to reflect these code changes to avoid claim denials.
Medium impact
11.08.15ae, Reconstructive Breast Surgery and Post-Mastectomy Prostheses
Independence Blue Cross·Effective Oct 1, 2026
Independence Blue Cross updated HCPCS codes L8030, L8031, and L8035 for breast prostheses to include 'any type' in their descriptions, effective 10/01/2026. This is a CPT/HCPCS code update memo that does not imply a full policy review. Billing teams must update claims systems to reflect the revised code descriptions for post-mastectomy prosthetic devices.
Medium impact
Skin and Tissue Substitutes - MEDICAID - INDIANA (New)
Humana·Effective May 20, 2026
New Indiana Medicaid policy establishes coverage criteria for skin and tissue substitutes specifically for diabetic foot ulcers and chronic venous leg ulcers lasting over 4 weeks when used with comprehensive standard wound therapy. The policy covers numerous HCPCS codes (A2001-A2035, C-codes, Q-codes) but requires strict medical necessity criteria including proper wound assessment, infection treatment, and glycemic control.
Low impact
11.08.15ae, Reconstructive Breast Surgery and Post-Mastectomy Prostheses
Independence Blue Cross·Effective Oct 1, 2026
Independence Blue Cross updated HCPCS codes L8030, L8031, and L8035 for breast prostheses to include 'any type' language effective October 1, 2026. This is a coding description update only; no coverage or benefit changes were made. Billing teams must update system records and encounter forms to reflect the revised code descriptions for post-mastectomy prosthetic devices.

All billing codes J3590 C9399 J3490 99213 99214 99212

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MA11.030j, Reconstructive Breast Surgery

Skin and Tissue Substitutes - MEDICAID - INDIANA (New)

MA11.030i, Reconstructive Breast Surgery

11.08.15ad, Reconstructive Breast Surgery and Post-Mastectomy Prostheses

11.08.15ae, Reconstructive Breast Surgery and Post-Mastectomy Prostheses

Skin and Tissue Substitutes - MEDICAID - INDIANA (New)

11.08.15ae, Reconstructive Breast Surgery and Post-Mastectomy Prostheses