Medicare AdvantageBilling CodesMedium impact
MA11.077j, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·General Surgery, OB-GYN, Oncology +1 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross updated MA11.077j to add three new ICD-10 diagnosis codes effective 10/01/2026: QA1.790 (Familial cancer syndrome with pathogenic BRCA1 mutation), QA1.791 (Familial cancer syndrome with pathogenic BRCA2 mutation), and QA1.792 (Li Fraumeni syndrome). These codes now qualify for coverage of prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures under Medicare Advantage plans.
Action Required
By September 15, 2026: Billing team must update billing software and claim submission systems to recognize the three new ICD-10 diagnosis codes (QA1.790, QA1.791, QA1.792) as valid medical necessity qualifiers for prophylactic mastectomy and related gynecological procedures under policy MA11.077j. Update medical coding references and provider documentation templates to include these familial cancer syndrome and Li-Fraumeni syndrome codes. Verify that claims submitted with these diagnosis codes on or after 10/01/2026 route to the correct coverage determination logic. Providers should be notified that patients with confirmed BRCA1/BRCA2 mutations (QA1.790, QA1.791) and Li-Fraumeni syndrome (QA1.792) now have clearer coding pathways for prior authorization and claims submission for these preventive procedures.