What insurance policy changes affect HCPCS C9399?

There are 24 tracked policy changes affecting HCPCS C9399, including updates from Indiana Medicaid (IHCP), Aetna, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS C9399?

Payers that have issued tracked updates for HCPCS C9399 include: Indiana Medicaid (IHCP), Aetna, Premera Blue Cross, BCBS Michigan, Blue Cross NC, Florida Blue, Anthem BCBS, UnitedHealthcare.

How do I get notified when HCPCS C9399 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS C9399. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS C9399?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

C9399 Insurance Policy Changes

HCPCS C9399 is referenced in 24 tracked payer policy changes from Indiana Medicaid (IHCP), Aetna, and 6 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9399 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact
BT2023148: IHCP to cover weight-loss medications in select cases under EPSDT
Indiana Medicaid (IHCP)·Effective Oct 31, 2023
Indiana Medicaid (IHCP) will now cover weight-loss medications Wegovy and Saxenda for members under age 21 through the EPSDT program with prior authorization. Providers must submit PA requests using generic codes J3490, J3590, or C9399 while specifying the exact drug name in the authorization process.
High impact
OfficeLink Updates - October 2024 notices and reminders (PDF)
Aetna·Effective Jan 1, 2025
Aetna is implementing multiple changes including new precertification requirements for specialty drugs (effective September-October 2024), pathology billing restrictions with Mohs surgeries, and several claim edits starting January 1, 2025. Most significantly, pathology codes will be denied when billed same-day as Mohs procedures unless for separate lesions.
High impact
OfficeLink Updates - February 2025 notices and reminders (PDF)
Aetna·Effective Feb 1, 2025
Aetna is implementing multiple billing changes including new precertification requirements for several drugs and procedures, eliminating facility fee reimbursement for hospital-owned practices when physician fees are already paid, and requiring adherence documentation codes for CPAP supplies.
High impact
OfficeLink Updates - July 2025 notices and reminders (PDF)
Aetna·Effective Jun 18, 2025
Aetna has updated its National Precertification List (NPL) with multiple changes effective June-July 2025, requiring new prior authorization for several specialty drugs (denosumab, ustekinumab, tocilizumab variants) while removing precertification requirements for electric scooters, orthognathic surgery, TMJ procedures, and Medicare hyperbaric oxygen therapy. Additionally, certain oncology immune checkpoint inhibitors will have reduced 90-day initial approval periods when administered in outpatient hospital settings starting October 1, 2025.
High impact
OfficeLink Updates - August 2025 notices and reminders (PDF)
Aetna·Effective Aug 1, 2025
Aetna is implementing three major changes: a new payment structure for Medicare inpatient stays 1+ midnight that pays faster at observation rates with appeal rights, new CPT code requirements for lesion excisions based on tissue depth, and expanded precertification requirements for multiple specialty drugs including biosimilars.
High impact
OfficeLink Updates - October 2025 notices and reminders (PDF)
Aetna·Effective Jan 1, 2026
Aetna is implementing multiple policy changes effective January 1, 2026, including new prior authorization requirements for inpatient rehabilitation, skilled nursing, and home health services in select states, plus updates to specialty drug administration policies and compression stocking coverage exclusions.
High impact
OfficeLink Updates - November 2025 notices and reminders (PDF)
Aetna·Effective Nov 1, 2025
Aetna is implementing multiple prior authorization changes for specialty drugs and procedures, removing precertification requirements for artificial insemination procedures, and requiring valid CPT/HCPCS codes for behavioral health services. Key changes take effect at various dates from November 2025 through February 2026.
High impact
OfficeLink Updates - January 2026 notices and reminders (PDF)
Aetna·Effective Apr 1, 2026
Aetna is implementing multiple policy changes effective April 1, 2026, including new prior authorization requirements for specialty drugs and procedures, bundling of medication-assisted treatment services, updated coding rules for ventral hernias, and new modifier requirements for reduced/discontinued services.
High impact
OfficeLink Updates - February 2026 notices and reminders (PDF)
Aetna·Effective Apr 1, 2026
Aetna is adding precertification requirements for 16 new specialty drugs and medical injectables, with most changes effective April 1, 2026. Additionally, Site of Care requirements will apply to two specific drugs for commercial plans starting April 1, 2026.
High impact
OfficeLink Updates - May 2026 notices and reminders (PDF)
Aetna·Effective May 1, 2026
Aetna has updated their National Precertification List with multiple changes taking effect between May 2026 and January 2027. Several drugs will now require precertification including ustekinumab-srlf, ranibizumab-nuna, and others, while Fulphila will no longer require precertification for Medicare patients.
High impact
Medical Policy and Coding Updates - June 2024
Premera Blue Cross·Effective Aug 2, 2024
Premera Blue Cross released comprehensive June 2024 policy updates affecting multiple specialties with new prior authorization requirements, coverage changes for genetic testing, and updated medical necessity criteria for various drugs and treatments. Key changes include new complement inhibitor policies, expanded genetic testing guidelines, and updated site of service reviews for specialty medications.
Medium impact
HCPCS replacement codes established, effective April 1, 2026
BCBS Michigan·Effective Apr 1, 2026
CMS established new HCPCS codes for 8 specialty medical drugs effective April 1, 2026, replacing temporary codes. The billing team must update their systems to use the new permanent codes for all services performed on or after April 1, 2026, while continuing to use old codes for services through March 31, 2026.
Medium impact
Medical Criteria Update for April 6, 2022
Blue Cross NC·Effective Apr 6, 2022
Blue Cross NC updated their medical criteria to add five new specialty drugs with associated HCPCS codes (Nexviazyme, Saphnelo, Tezspire, Enjaymo, and Leqvio) and updated the HCPCS code for Evkeeza from a temporary code to permanent code J1305. These changes provide clarity for billing these specialty medications.
High impact
Medical Policy Update for December 29, 2023
Blue Cross NC·Effective Jan 1, 2024
Blue Cross NC updated multiple medical policies effective January 1, 2024, with extensive CPT and HCPCS code changes across numerous specialties. Key changes include new codes for procedures like phrenic nerve stimulation, bone density studies, and various ablation techniques, plus removal of outdated temporary codes.
Medium impact
Medicare Part B Step Therapy Product Updates
Florida Blue·Effective Jul 15, 2025
Florida Blue Medicare updated its Part B Step Therapy program effective July 15, 2025, removing Erythropoiesis Stimulating Agents from step therapy requirements and adding new non-preferred drugs in Cancer/Supportive Therapy, Complement Inhibitors, and Ophthalmic Agents categories that will require step therapy through preferred alternatives first.
High impact
Updated Categories for Medicare Advantage Part B Step Therapy
Florida Blue·Effective Sep 15, 2025
Florida Blue Medicare updated its Part B Step Therapy program effective September 15, 2025, adding new non-preferred drugs to four categories that now require step therapy and prior authorization. Billing teams must ensure preferred alternatives are tried first or obtain prior authorization for the newly added non-preferred medications.
High impact
Medicare Part B Step Therapy Product Updates
Florida Blue·Effective Jan 1, 2026
Florida Blue Medicare updated its Part B Step Therapy programs for Medicare Advantage plans, effective January 1, 2026. Multiple drug categories now have new preferred and non-preferred medications, requiring step therapy trials of preferred products before non-preferred drugs can be approved.
High impact
Medicare Part B Step Therapy May Updates
Florida Blue·Effective May 15, 2026
Florida Blue Medicare updated its Part B Step Therapy program effective May 15, 2026, adding new non-preferred drugs and changing preferred status for medications in Asthma, Cancer, and Hemophilia categories. Providers must try preferred alternatives before prescribing non-preferred drugs or face coverage denials.
Medium impact
[California] Anthem expands specialty pharmacy precertification list
Anthem BCBS·Effective Sep 1, 2026
Anthem is adding two new specialty Medicare Part B drugs (Fesilty and Loargys) to their precertification requirement list effective September 1, 2026. Claims for these drugs will be denied without prior authorization approval.
Medium impact
[New York] Anthem expands specialty pharmacy precertification list
Anthem BCBS·Effective Sep 1, 2026
Anthem is adding two new specialty Medicare Part B drugs to their precertification requirements: Fesilty (fibrinogen, human‑chmt) and Loargys (pegzilarginase‑nbln), both billed under codes C9399 and J3590. Claims for these drugs will require prior authorization starting September 1, 2026, and may be denied without proper precertification.
Medium impact
[Ohio] Anthem expands specialty pharmacy precertification list
Anthem BCBS·Effective Sep 1, 2026
Anthem is adding two specialty Medicare Part B drugs (Fesilty and Loargys) to their precertification requirement list effective September 1, 2026. These drugs will require prior authorization approval before administration to avoid claim denials.
Medium impact
[Virginia] Anthem expands specialty pharmacy precertification list
Anthem BCBS·Effective Sep 1, 2026
Anthem Virginia is adding two specialty Medicare Part B drugs (Fesilty and Loargys) to their precertification requirement list effective September 1, 2026. These drugs will require prior authorization before administration to avoid claim denials.
Medium impact
[Georgia] Anthem expands specialty pharmacy precertification list
Anthem BCBS·Effective Sep 1, 2026
Anthem Blue Cross and Blue Shield of Georgia is adding two new specialty Medicare Part B drugs (Fesilty and Loargys) to their precertification requirement list. Claims for these drugs will be denied if prior authorization is not obtained before administration.
Medium impact
North Carolina Medicaid: Prior authorization updates for specialty pharmacy medications
UnitedHealthcare·Effective Dec 1, 2025
Starting December 1, 2025, UnitedHealthcare Community Plan in North Carolina will require prior authorization for 10 specialty gene and cell therapy medications. Some therapies require contacting Optum Transplant Services directly at 888-805-1802 instead of using the standard portal.

All billing codes J3590 J3490 T1015 99214 99205 T1016

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BT2023148: IHCP to cover weight-loss medications in select cases under EPSDT

OfficeLink Updates - October 2024 notices and reminders (PDF)

OfficeLink Updates - February 2025 notices and reminders (PDF)

OfficeLink Updates - July 2025 notices and reminders (PDF)

OfficeLink Updates - August 2025 notices and reminders (PDF)

OfficeLink Updates - October 2025 notices and reminders (PDF)

OfficeLink Updates - November 2025 notices and reminders (PDF)

OfficeLink Updates - January 2026 notices and reminders (PDF)

OfficeLink Updates - February 2026 notices and reminders (PDF)

OfficeLink Updates - May 2026 notices and reminders (PDF)

Medical Policy and Coding Updates - June 2024

HCPCS replacement codes established, effective April 1, 2026

Medical Criteria Update for April 6, 2022

Medical Policy Update for December 29, 2023

Medicare Part B Step Therapy Product Updates

Updated Categories for Medicare Advantage Part B Step Therapy

Medicare Part B Step Therapy Product Updates

Medicare Part B Step Therapy May Updates

[California] Anthem expands specialty pharmacy precertification list

[New York] Anthem expands specialty pharmacy precertification list

[Ohio] Anthem expands specialty pharmacy precertification list

[Virginia] Anthem expands specialty pharmacy precertification list

[Georgia] Anthem expands specialty pharmacy precertification list

North Carolina Medicaid: Prior authorization updates for specialty pharmacy medications