ICD-10 A81.00 is officially defined as "Creutzfeldt-Jakob disease, unspecified." code A81.00 is referenced in 3 tracked payer policy changes from Humana and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code A81.00 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Humana Louisiana Medicaid has implemented a new antipsychotic utilization program requiring prior authorization for antipsychotic medications prescribed to patients with documented dementia diagnoses. The program includes strict age-based criteria and specific compendia-supported indications for approval.
This Aetna policy addresses metagenomic next-generation sequencing, multiplex immunoassay tests, molecular syndromic panels and other tests for infectious diseases that do not fit in other bulletins. RT-QuIC is considered medically necessary for evaluating individuals with rapidly progressive dementia suspected of prion disease, and syphilis non-treponemal and treponemal tests are considered medically necessary for screening all pregnant women and persons at risk of syphilis, and for diagnostic testing of individuals with signs and symptoms of syphilis. Aetna considers named tests such as the Karius Test, IntelliSep, MeMed BV, TriVerity and the Synovasure Comprehensive PJI Test Panel experimental, investigational or unproven.
Aetna considers quantitative EEG (brain mapping, also called BEAM) medically necessary only as an adjunct to traditional EEG for specified uses, including ambulatory EEG recording to facilitate later expert visual interpretation, continuous EEG monitoring by frequency-trending in the operating room or ICU, and topographic voltage and dipole analysis in pre-surgical evaluations for intractable epilepsy. Aetna considers quantitative EEG experimental, investigational or unproven for all other indications, including attention disorders, autism spectrum disorders, depression, schizophrenia, bipolar disorder, insomnia, fibromyalgia, post-traumatic stress disorder and post-concussion syndrome. The BrainScope One System (Ahead 300) is considered experimental, investigational or unproven for evaluation of concussion or traumatic brain injury.
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