B18.0 Insurance Policy Changes

ICD-10 B18.0 is officially defined as "Chronic viral hepatitis B with delta-agent." code B18.0 is referenced in 10 tracked payer policy changes from Aetna and Healthfirst. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code B18.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 29, 2026Medium impact
Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-10-26)
This Aetna Clinical Policy Bulletin (CPB 0690) addresses noninvasive tests for hepatic fibrosis and lists which tests Aetna considers medically necessary and which it considers experimental, investigational, or unproven. Aetna considers transient elastography (e.g., FibroScan) medically necessary for follow-up of primary sclerosing cholangitis, monitoring of liver function in Wilson's disease, and distinguishing hepatic cirrhosis from non-cirrhosis in persons with hepatitis B, hepatitis C or other chronic liver diseases. Performing transient elastography, magnetic resonance elastography, the Enhanced Liver Fibrosis (ELF) test, or FibroTest-ActiTest/HCV-FibroSure more than twice per year is considered not medically necessary.
Aetna · Identified Oct 10, 2026Medium impact
Immune Globulins for Post-Exposure Prophylaxis (CPB 0544, reviewed 2026-10-07)
Aetna considers immune globulins medically necessary for hepatitis B, cytomegalovirus, Rho-D, rabies, varicella zoster, tetanus, vaccinia, botulism, hepatitis A, measles (rubeola) and rubella exposures or conditions, and considers all other indications experimental, investigational, or unproven. Each product has its own initial criteria, such as hepatitis B immune globulin for members who had contact with an individual diagnosed with hepatitis B virus, Rho-D immune globulin for unsensitized Rh-negative women at 24 to 28 weeks gestation unless the father is known to be Rh-negative, and varicella zoster immune globulin for high-risk individuals with significant exposure to varicella. Continuation of therapy for each product is considered medically necessary for all members, including new members, who meet all initial medical necessity criteria.
Aetna · Identified Oct 6, 2026Medium impact
Pegzilarginase-nbln (Loargys) (CPB 1101)
Aetna's new clinical policy bulletin (CPB 1101, source dated 2026-10-06) sets the criteria for pegzilarginase-nbln (Loargys) on commercial medical plans for arginase 1 deficiency in patients aged 2 to under 32. Precertification is required, the drug must be prescribed by or with a metabolic or enzyme disorder specialist, and Aetna treats all other indications as experimental, investigational or unproven. No effective date is stated in the source, so check current applicability before acting.
Aetna · Identified Oct 3, 2026Medium impact
Interferons (CPB 0404, reviewed 2026-09-10)
Aetna's interferon policy covers Actimmune (interferon gamma-1b) for chronic granulomatous disease, mycosis fungoides/Sezary syndrome and severe malignant osteopetrosis, and considers all other indications experimental, investigational, or unproven. Pegasys (peginterferon alfa-2a) and Besremi (ropeginterferon alfa-2b-njft) each have their own list of covered indications, and several Besremi indications are covered only when Pegasys is unavailable. Aetna considers continuation of therapy medically necessary for members who are experiencing benefit, as evidenced by disease stability or disease improvement, and the Biojector 2000 needle-free injection system is considered a medically necessary alternative to needles for members with exacerbating-remitting MS who cannot safely self-inject due to tremors and decreased coordination.
Aetna · Identified Aug 19, 2026Medium impact
Intestinal Transplantation (CPB 0605, reviewed 2025-09-10)
Aetna considers intestinal transplantation medically necessary for persons with clinical indicators of failed total parenteral nutrition (TPN) who meet the selection criteria. The selection criteria include absence of acute or chronic active infections that are not effectively treated, an ejection fraction greater than or equal to 40%, a bilirubin of less than 2.5 mg/dL, a creatinine clearance greater than 50 mL/min/kg, and controlled HIV/AIDS. Intestinal transplant is considered not medically necessary for persons with contraindications such as refractory heart failure with an ejection fraction less than 40%, untreated malignancy, multi-organ failure, sepsis, or inability to adhere to the transplant regimen, including homelessness, active substance abuse, or unstable psychiatric disease.
Aetna · Identified Aug 18, 2026Medium impact
Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-06-18)
Aetna's Clinical Policy Bulletin 0690 on noninvasive tests for hepatic fibrosis, reviewed 2026-06-18, states which tests it considers medically necessary and which it considers experimental, investigational or unproven. Aetna considers transient elastography (e.g., FibroScan), FibroTest-ActiTest/HCV-FibroSure, magnetic resonance elastography and the Enhanced Liver Fibrosis (ELF) test medically necessary for the indications listed, and considers baseline liver elastography medically necessary for persons with cystic fibrosis who have hepatobiliary involvement. Each of the four tests is considered not medically necessary if performed more than twice per year. Transient elastography and FibroTest-ActiTest/HCV-FibroSure are considered not medically necessary within 6 months of a liver biopsy or of each other, and magnetic resonance elastography and ELF are considered not medically necessary within 6 months of a liver biopsy or another test for liver fibrosis. ARFI, LiverMultiScan, artificial intelligence for NAFLD, NASHnext and the OWLiver Panel are listed as experimental, investigational or unproven for the uses the policy names.
Aetna · Identified Aug 17, 2026Medium impact
ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)
Aetna considers the ADAMTS13 assay medically necessary for assessing prognosis in persons with thrombotic thrombocytopenic purpura (TTP), and for distinguishing hematopoietic stem cell transplant-associated thrombotic microangiopathy (HSCT-TMA, also called transplant-associated TMA) from TTP in persons with overlapping features when the test will be used to inform treatment. Aetna considers the assay experimental, investigational, or unproven for the uses it lists because of insufficient evidence, including sepsis-associated thrombotic microangiopathy, hemolytic uremic syndrome, acute myelogenous leukemia, colorectal cancer survival, COVID-19, cerebral infarction, and ADAMTS13 mutation testing for non-cirrhotic portal hypertension.
Aetna · Identified Aug 15, 2026Medium impact
Extracorporeal Immunoadsorption (Prosorba Column) (CPB 0355, reviewed 2026-05-26)
Aetna considers extracorporeal immunoadsorption (ECI, Prosorba column) medically necessary for hemolytic uremic syndrome and idiopathic thrombocytopenic purpura with clinical evidence of serious bleeding with platelet count below 50,000 or the potential for serious bleeding with platelet count below 20,000, for last resort treatment of life-threatening systemic lupus erythematosus when conventional therapy has failed, for moderate-to-severe rheumatoid arthritis in members who have failed other treatments, for myasthenic crisis when conventional therapy has failed, and for pemphigus vulgaris resistant to standard therapy. ECI is experimental, investigational, or unproven for all other indications, including allergic asthma, atopic dermatitis, anti-phospholipid syndrome, COVID-19, dermatomyositis, heart failure, hepatitis B, idiopathic inflammatory myopathy, interstitial lung disease or pneumonia, and prevention of attacks or progression of neuromyelitis optica spectrum disorder. CPT 36516 is covered if the selection criteria are met.
Aetna · Identified Aug 12, 2026Medium impact
Onasemnogene Abeparvovec (Zolgensma and Itvisma) (CPB 0953, reviewed 2026-08-10)
Aetna's clinical policy bulletin covers onasemnogene abeparvovec (Zolgensma and Itvisma) for commercial medical plans and requires precertification of all Aetna participating providers and members in applicable plan designs. Aetna considers Zolgensma medically necessary as a single-dose intravenous infusion for spinal muscular atrophy (SMA) when the member is less than 2 years of age, has a genetically confirmed diagnosis with bi-allelic SMN1 variants and 3 or fewer copies of SMN2, and meets the other listed criteria, and considers Itvisma medically necessary as a single intrathecal dose for SMA when the member is 2 to less than 18 years of age, had onset of signs and symptoms at 6 months of age or older, and meets the other listed criteria. Aetna considers both products experimental, investigational, or unproven for all other indications, and considers repeat administration of onasemnogene abeparvovec experimental, investigational, or unproven.
Healthfirst · Identified Jun 20, 2026Medium impact
May is Hepatitis Awareness Month: Documentation and Coding Resources for Your Practice
Healthfirst has issued comprehensive documentation and coding guidance for chronic hepatitis conditions in recognition of Hepatitis Awareness Month. This educational resource provides specific ICD-10-CM codes, documentation requirements, and coding examples to help providers accurately code hepatitis-related diagnoses and avoid common coding errors.

Watch B18.0

Get one email when a payer policy names B18.0, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code B18.0?

There are 10 tracked policy changes affecting code B18.0, including updates from Aetna, Healthfirst. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code B18.0?

Payers that have issued tracked updates for code B18.0 include: Aetna, Healthfirst.

How do I get notified when code B18.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code B18.0. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code B18.0?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-10-26)

Immune Globulins for Post-Exposure Prophylaxis (CPB 0544, reviewed 2026-10-07)

Pegzilarginase-nbln (Loargys) (CPB 1101)

Interferons (CPB 0404, reviewed 2026-09-10)

Intestinal Transplantation (CPB 0605, reviewed 2025-09-10)

Noninvasive Tests for Hepatic Fibrosis (CPB 0690, reviewed 2026-06-18)

ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)

Extracorporeal Immunoadsorption (Prosorba Column) (CPB 0355, reviewed 2026-05-26)

Onasemnogene Abeparvovec (Zolgensma and Itvisma) (CPB 0953, reviewed 2026-08-10)

May is Hepatitis Awareness Month: Documentation and Coding Resources for Your Practice

What insurance policy changes affect code B18.0?

Which payers have updated policy for code B18.0?

How do I get notified when code B18.0 policy changes?

Why do payers change policies for code B18.0?