Medicare AdvantageBilling CodesMedium impact
MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·General Surgery, OB-GYN, Oncology +1 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA11.077i to MA11.077j, adding nine new ICD-10 diagnosis codes (effective 10/01/2025) related to inflammatory breast cancer, fallopian tube conditions, and prophylactic surgery encounters. The policy reissued on 04/01/2026 to reaffirm the Company's continuing position on prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy coverage criteria without substantive changes to medical necessity standards.
Action Required
By 10/01/2025: Billing team must update diagnosis code validation rules in the billing system 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) for prophylactic surgery claims. Update claim scrubbing logic to prevent denials when these codes are paired with CPT codes 19303, 58150, 58180, 58262, 58263, 58291, and 58542. Notify providers to update encounter documentation templates to include fallopian tube history and inflammatory breast cancer diagnoses where clinically relevant. Failure to update billing rules will result in claim denials for encounters using the new diagnosis codes.