CommercialBilling CodesMedium impact
11.08.19t, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·OB-GYN, General Surgery, Oncology +1 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross updated policy 11.08.19t with three new ICD-10 diagnosis codes effective 10/01/2026 to support coverage determinations for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy in patients with familial cancer syndromes. The billing team must ensure these new codes (QA1.790, QA1.791, QA1.792) are recognized in billing systems and attached to claims for these procedures when applicable.
Action Required
By October 1, 2026: Billing team must update billing system and claim submission software to recognize three new ICD-10 diagnosis codes: QA1.790 (Familial cancer syndrome with pathogenic BRCA1 mutation), QA1.791 (Familial cancer syndrome with pathogenic BRCA2 mutation), and QA1.792 (Li Fraumeni syndrome). Ensure these codes are available for attachment to CPT codes 19303, 58150, 58180, 58262, 58263, 58291, and 58542 when prophylactic surgery claims are submitted to Independence Blue Cross. Update clinical documentation templates and prior authorization forms to include these new diagnostic codes. Failure to include appropriate ICD-10 codes may result in claim denials or delays for Independence Blue Cross commercial members.