CommercialBilling CodesMedium impact
11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·PA · General Surgery, OB-GYN, Oncology +1 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued policy 11.08.19s (now version 11.08.19t) for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy with updated ICD-10 codes effective 10/01/2025. Nine new diagnosis codes have been added to support coverage determinations, including codes for inflammatory breast cancer, genetic susceptibility to fallopian tube malignancy, and family/personal history of fallopian tube cancer. The coverage criteria and medical necessity standards remain unchanged from the prior version.
Action Required
By 10/01/2025, billing and coding staff must update claim submission systems to recognize and appropriately link the nine newly added ICD-10 diagnosis codes (C50.A0, C50.A1, C50.A2, Z15.05, Z40.81, Z40.82, Z80.44, Z85.4A, Z86.00A) to the existing CPT procedure codes (19303, 58150, 58180, 58262, 58263, 58291, 58542) for prophylactic surgery coverage determinations. Verify that the practice's encoder/billing software has been updated to the October 2025 ICD-10 code set. Train billing staff to use these codes when submitting claims for prophylactic mastectomy, oophorectomy, salpingo-oophorectomy, and hysterectomy procedures to ensure claims are evaluated under the correct medical necessity criteria. Review any pending or denied claims from 10/01/2025 forward that may have been rejected due to missing code mappings and resubmit with corrected diagnoses. Failure to update coding systems may result in claim denials or delays in processing.