Medicare AdvantageBilling CodesMedium impact
MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·OB-GYN, General Surgery, 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 to support coding for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures. The policy itself was reissued on 04/01/2026 to reaffirm the Company's continuing coverage position; no changes to medical necessity criteria or procedure coverage occurred.
Action Required
By 10/01/2025: Billing team must update billing software and claim submission systems to recognize and properly code 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) when submitting claims for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures under this policy. Update EMR templates and encounter forms to reflect new code availability. Verify that existing CPT codes (19303, 58150, 58180, 58262, 58263, 58291, 58542) remain correctly mapped to updated diagnosis codes. Train billing and coding staff on appropriate code selection based on patient family history, genetic risk factors, and surgical indications. Failure to use updated codes may result in claim processing delays or denials for services rendered on or after 10/01/2025.