E11.40 Insurance Policy Changes

ICD-10 E11.40 is officially defined as "Type 2 diabetes mellitus with diabetic neuropathy, unspecified." code E11.40 is referenced in 10 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E11.40 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 26, 2026Medium impact
Pulsed Radiofrequency (CPB 0735, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0735 considers pulsed radiofrequency experimental, investigational, or unproven for all indications in its list, because its effectiveness has not been established. The list includes indications such as carpal tunnel syndrome, chronic knee pain, low back pain, trigeminal neuralgia, and headache. The policy also considers the Stimpod NMS460 nerve stimulator for post-amputation pain, combined ganglion impar block and pulsed radiofrequency for pudendal neuralgia, and combined platelet-rich plasma to the Gasserian ganglion and pulsed radiofrequency for trigeminal neuralgia experimental, investigational, or unproven.
Aetna · Identified Oct 25, 2026Medium impact
Diabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0729 sets the medical necessity rules for selected treatments of diabetic neuropathy. Percutaneous electrical stimulation is considered medically necessary for members who failed to adequately respond to conventional treatments, but use for more than 4 weeks is considered not medically necessary, and dorsal column stimulation is medically necessary for members who meet the criteria in CPB 0194 - Spinal Cord Stimulation. The bulletin lists many other interventions, including acupuncture, dorsal root ganglion stimulation, peripheral nerve blocks and tumor necrosis factor-alpha inhibitors, as experimental, investigational, or unproven for this indication.
Aetna · Identified Oct 16, 2026Medium impact
Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-10-14)
Aetna considers TENS units medically necessary durable medical equipment when used as an adjunct or alternative to drugs for acute post-operative pain in the first 30 days after surgery, or for certain chronic, intractable pain not adequately responsive to other methods. Peripherally implanted nerve stimulators are considered medically necessary for intractable neuropathic pain when all listed criteria are met. Percutaneous electrical nerve stimulation is considered medically necessary for chronic low back pain secondary to degenerative disc disease for up to a 30-day period within a multi-modality rehabilitation program, and for diabetic neuropathy or neuropathic pain that has not responded to listed medications. Many other electrical stimulation devices and indications are listed as experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Holter Monitors (CPB 0019, reviewed 2026-03-13)
Aetna considers Holter monitoring medically necessary for diagnostic evaluation of adult members with listed conditions, including palpitations, syncope or near syncope, unexplained dizziness, and possible or documented long QT syndrome, and for asymptomatic congenital complete atrioventricular block in pediatric patients. Holter monitoring is considered experimental, investigational, or unproven for all other indications because its effectiveness for those indications has not been established. CPT codes 93224, 93225, 93226 and 93227 are covered if the selection criteria are met.
Aetna · Identified Aug 16, 2026Medium impact
Retinopathy Telescreening Systems (CPB 0563, reviewed 2026-08-06)
Aetna considers retinopathy telescreening systems medically necessary for screening diabetic retinopathy and retinopathy of prematurity as an alternative to screening by an ophthalmologist or optometrist. Aetna considers AI-based systems experimental, investigational, or unproven for screening retinopathy of prematurity, and considers telescreening experimental for following disease progression in members diagnosed with diabetic retinopathy and for screening retinal conditions other than diabetic retinopathy or retinopathy of prematurity, including macular degeneration or edema. CPT 92227, 92228 and 92229 are covered when the selection criteria are met, and 92229 is not covered for retinopathy of prematurity screening.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)
Quantitative sensory testing (QST), current perception threshold (CPT) testing, voltage-actuated sensory nerve conduction threshold (VsNCT) testing, and quantitative thermal testing for early diagnosis of leprosy are considered experimental, investigational, or unproven for the uses listed in this policy, because their effectiveness or clinical value has not been established. Listed uses include evaluating fibromyalgia pain, chronic itch, chronic pelvic pain, and shoulder pain, and diagnosing restless legs syndrome and small fiber neuropathy in postural orthostatic tachycardia syndrome. CPT codes 0106T through 0110T and HCPCS code G0255 are not covered for the listed indications.
Aetna · Identified Aug 14, 2026Medium impact
Diabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-02-24)
Aetna considers percutaneous electrical stimulation medically necessary for diabetic neuropathy only for members who did not respond adequately to conventional treatments, including anti-convulsants (especially pregabalin), anti-depressants (such as amitriptyline and duloxetine), and other agents such as capsaicin and isosorbide dinitrate spray. Use of percutaneous electrical stimulation for more than 4 weeks for diabetic neuropathy is considered not medically necessary. Dorsal column stimulation is considered medically necessary for members with diabetic peripheral neuropathy who meet the criteria in CPB 0194 (Spinal Cord Stimulation), while acupuncture, dorsal root ganglion stimulation, ozone therapy, peripheral nerve blocks and low-level laser therapy are considered experimental, investigational, or unproven for diabetic neuropathy because their clinical value for this indication has not been established.
Aetna · Identified Aug 13, 2026Medium impact
Pedobarography (CPB 0294, reviewed 2026-04-17)
Aetna considers pedobarography (foot pressure studies) experimental, investigational, or unproven, because the medical literature does not contain reliable evidence that it improves diagnosis and management of foot conditions or health outcomes. CPT 96001, comprehensive computer-based motion analysis with dynamic plantar pressure measurements during walking, is listed as not covered for the indications in this policy. Related CPT codes include motion analysis, surface electromyography and physician interpretation, related HCPCS codes include ankle-foot orthoses and orthopedic shoes, and ICD-10 codes for diabetes with neurological complications, pressure ulcers of the ankle and heel, and osteoarthritis of the ankle and foot are listed as not covered for these indications.
Aetna · Identified Aug 12, 2026Medium impact
Orthopedic Casts, Braces and Splints (CPB 0009, reviewed 2026-01-20)
Aetna considers orthoses, casts and splints medically necessary when they treat disease or injury for the listed indications, including lumbar and thoracic-lumbar-sacral braces that facilitate healing after a spine injury or spinal surgery, post-operative back braces applied within 6 weeks after spinal surgery, cervical braces for neck injury and torticollis, Unna boots for non-fracture care, air casts for fractures or other injuries, and prefabricated volar wrist braces for carpal tunnel syndrome. Prophylactic lumbar supports are considered experimental, investigational, or unproven, and elastic support garments and protective body socks do not meet Aetna's definition of covered durable medical equipment. Custom-fitted back braces are medically necessary where there is a failure, contraindication or intolerance to an unmodified, prefabricated back brace, and medical record documentation must support all coverage criteria because supplier-prepared statements and practitioner attestations alone are not sufficient.
Aetna · Identified Aug 12, 2026Medium impact
Autonomic Testing / Sudomotor Tests (CPB 0485, reviewed 2026-08-11)
Aetna considers autonomic testing, including quantitative sudomotor axon reflex test (QSART), silastic sweat imprint, and thermoregulatory sweat test (TST), medically necessary as a diagnostic tool for amyloid neuropathy, autoimmune autonomic ganglionopathy, diabetic autonomic neuropathy, distal small fiber neuropathy, idiopathic neuropathy, long-COVID syndrome with suspected autonomic disorder, multiple system atrophy, orthostatic hypotension, Parkinson disease, postural tachycardia syndrome, pure autonomic failure, recurrent unexplained syncope, reflex sympathetic dystrophy or causalgia, and Sjogren's syndrome. Aetna considers autonomic testing experimental, investigational, or unproven for other indications, including chronic fatigue syndrome/myalgic encephalomyelitis, concussion, predicting foot ulcers, Raynaud phenomenon, traumatic brachial plexus injury, and traumatic brain injury. Sympathetic skin response testing, EZSCAN, SudoScan, QDIRT, QPART, VitalScan Systems, and automated devices that generate their own software interpretation are considered experimental, investigational, or unproven for the uses listed in the policy.

Watch E11.40

Get one email when a payer policy names E11.40, 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 E11.40?

There are 10 tracked policy changes affecting code E11.40, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E11.40?

Payers that have issued tracked updates for code E11.40 include: Aetna.

How do I get notified when code E11.40 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E11.40. 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 E11.40?

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

Pulsed Radiofrequency (CPB 0735, reviewed 2026-10-21)

Diabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-10-21)

Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-10-14)

Holter Monitors (CPB 0019, reviewed 2026-03-13)

Retinopathy Telescreening Systems (CPB 0563, reviewed 2026-08-06)

Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)

Diabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-02-24)

Pedobarography (CPB 0294, reviewed 2026-04-17)

Orthopedic Casts, Braces and Splints (CPB 0009, reviewed 2026-01-20)

Autonomic Testing / Sudomotor Tests (CPB 0485, reviewed 2026-08-11)

What insurance policy changes affect code E11.40?

Which payers have updated policy for code E11.40?

How do I get notified when code E11.40 policy changes?

Why do payers change policies for code E11.40?