What insurance policy changes affect CPT 90935?

There are 5 tracked policy changes affecting CPT 90935, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 90935?

Payers that have issued tracked updates for CPT 90935 include: Aetna.

How do I get notified when CPT 90935 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 90935. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 90935?

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.

90935 — A doctor's assessment visit to check on how well your kidney dialysis treatment is working and your overall health status.: Insurance Policy Changes

90935 Insurance Policy Changes

CPT 90935, in plain terms, covers A doctor's assessment visit to check on how well your kidney dialysis treatment is working and your overall health status. CPT 90935 is referenced in 5 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 90935 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Marnetegragene Autotemcel (Kresladi) (CPB 1102, reviewed 13-2026-07)

Aetna·Identified Aug 27, 2026

Aetna has established a new clinical policy (CPB 1102) for Marnetegragene Autotemcel (Kresladi), a gene therapy for severe leukocyte adhesion deficiency-I (LAD-I) in pediatric patients ages 9 months to <10 years. This is a one-time, single-dose autologous stem cell therapy requiring mandatory precertification through National Medical Excellence (877-212-8811) and administration at an Aetna Institutes GCIT Designated Network. Billing teams must implement precertification workflows and ensure strict compliance with 16 specific approval criteria before claims can be submitted.

90935 Insurance Policy Changes

Dialysis (CPB 0541, reviewed 2025-11-26)

Crit-Line In-Line Monitor (CPB 0373, reviewed 2026-05-26)

Daprodustat (Jesduvroq) (CPB 1044, reviewed 2026-01-27)

Dialysis (CPB 0541, reviewed 2026-08-26)

Marnetegragene Autotemcel (Kresladi) (CPB 1102, reviewed 13-2026-07)