CommercialBilling CodesLow impact
11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·PA · OB-GYN, General Surgery, Oncology +1 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 11.08.19s on 04/01/2026 to reaffirm coverage for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy in high-risk and moderately increased-risk individuals. Nine new ICD-10 diagnosis codes were added effective 10/01/2025 to support claims related to inflammatory breast cancer, genetic susceptibility to fallopian tube malignancies, and family/personal history of fallopian tube neoplasms. No changes to coverage criteria, CPT codes, or billing requirements were made.
Action Required
By 10/01/2025: Billing team must update diagnosis code sets in the billing system and EMR to recognize and accept the nine newly added ICD-10 codes (C50.A0, C50.A1, C50.A2, Z15.05, Z40.81, Z40.82, Z80.44, Z85.4A, Z86.00A) when submitting claims for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures. Update coding templates and encounter forms to include these codes as valid supporting diagnoses for procedures 19303, 58150, 58180, 58262, 58263, and 58542. No prior authorization workflow changes are required. Failure to use correct diagnosis codes may result in claim denials or delays.