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Independence Blue CrossCommercial · Billing Codes · Medical Policy · Cardiology, Internal Medicine, Radiology +1 moreMedium impact

09.00.58a, Coronary Artery Calcium (CAC) Testing Using Computed Tomography (Independence Administrators)

Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Administrators updated policy 09.00.58a effective 10/01/2025 to replace the generic ICD-10 code E78.01 (Familial hypercholesterolemia) with three more specific codes: E78.010 (Homozygous), E78.011 (Heterozygous), and E78.019 (Unspecified). Billing teams must update their systems to use the new granular diagnosis codes when submitting CAC testing claims for familial hypercholesterolemia cases.

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What to do

Action · 4 steps
01By 10/01/2025: Billing team must update billing software and encounter forms to replace ICD-10 code E78.01 with the three new granular codes (E78.010, E78.011, E78.019) when billing CAC testing (CPT 75571) for Independence Administrators members with familial hypercholesterolemia.
02Train providers and billing staff to select the appropriate code based on whether the patient has homozygous, heterozygous, or unspecified familial hypercholesterolemia.
03Do not use the terminated code E78.01 on claims submitted on or after 10/01/2025, as it will result in claim denials.
04Verify member eligibility and that the group has not enrolled in Carelon Medical Benefits Management before applying this policy.

Codes mentioned

75571E78.010E78.011E78.019E78.00

Original notice

09.00.58a, Coronary Artery Calcium (CAC) Testing Using Computed Tomography (Independence Administrators)
medpolicy.ibx.com · Always check the source before changing claims.
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Related policy hubs

Independence Blue Cross policiesCardiologyInternal MedicineRadiologyFamily MedicineCode 75571Code E78.010Code E78.011Code E78.019Code E78.00

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