CommercialBilling CodesLow impact
09.00.49p, Proton Beam Radiation Therapy (Independence Administrators)
Independence Blue Cross·Radiation Oncology, Oncology·Medical Policy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Administrators updated Policy 09.00.49p for Proton Beam Radiation Therapy effective 10/01/2026 as part of a CPT code update. Two ICD-10 diagnosis codes for secondary malignant neoplasms of the pharynx and oral cavity were added to Attachment B (NOT MEDICALLY NECESSARY). This is a minor coding update that does not reflect a full policy review.
Action Required
By September 30, 2026: Billing team must update system references to ensure ICD-10 codes C78.32 (Secondary malignant neoplasm of pharynx) and C79.83 (Secondary malignant neoplasm of oral cavity) are classified as NOT MEDICALLY NECESSARY in Attachment B of Policy 09.00.49p. When these diagnoses appear on proton beam radiation therapy claims for Independence Administrators members, flag for medical necessity review and potential denial. Update internal policy documentation and billing guidelines to reflect the 10/01/2026 effective date. Note: This update applies only to groups whose coverage is administered by Independence Administrators and who have NOT enrolled in the UM vendor program.