Summary
Independence Blue Cross reissued MA11.069f reduction mammoplasty policy on 04/30/2025 to reaffirm its position with minor criterion updates. The policy was revised to align with Medicare coverage criteria, and diagnosis code N65.1 (Disproportion of reconstructed breast) was reclassified from Clinical Symptom to Primary Diagnosis, affecting how claims are coded and submitted.
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What to do
Action · 3 steps
01By 05/31/2025: Billing team must update coding guidelines to reflect N65.1 (Disproportion of reconstructed breast) as a PRIMARY DIAGNOSIS rather than a clinical symptom when submitting reduction mammoplasty claims (CPT 19318, 15877) to Independence Blue Cross Medicare Advantage plans.
02Update claim submission templates, EMR documentation requirements, and provider education materials to ensure N65.1 is used as the primary diagnosis code for reconstruction-related symmetry cases.
03Audit recent claims (past 90 days) coded with N65.1 as a secondary diagnosis and resubmit if applicable.
If missed: Failure to code N65.1 as primary diagnosis when clinically appropriate may result in claim denials or delayed payment.
Codes mentioned
1931815877N62N65.1L26L30.4L54L95.1L98.2M25.511M25.512M54.2M54.6M54.9N61.1
Original notice
MA11.069f, Reduction Mammoplasty
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →11.08.02l, Reduction MammoplastyMediumEffective Jun 3, 2024 · Claims & Billing11.08.12i, Surgery for GynecomastiaLowNo effective date · Medical Policy11.08.12i, Surgery for GynecomastiaLowNo effective date · Medical PolicyMA11.073f, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant SkinMediumEffective Dec 29, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list