E13.00 Insurance Policy Changes

ICD-10 E13.00 is officially defined as "Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)." code E13.00 is referenced in 5 tracked payer policy changes from Aetna, Excellus BlueCross BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E13.00 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective May 31, 2026High impact
Remote Physiologic Monitoring (RPM) (CPB 1093, reviewed 2026-05-31)
Aetna has clarified its Remote Physiologic Monitoring (RPM) coverage policy (CPB 1093, effective 2026-05-31) establishing strict medical necessity criteria for three conditions: heart failure, hypertension, and diabetes. RPM is now only covered when using FDA-approved devices with automatic data transmission, documented patient consent, provider ordering/supervision, and clinical impact on treatment plans. Coverage is limited to one episode per patient per condition per provider per month. Billing teams must verify all criteria are met before submitting claims and ensure documentation supports medical necessity.
Excellus BlueCross BlueShield · Effective Jan 1, 2026High impact
Continuous Glucose Monitoring Systems/External Insulin Pump Therapy for Diabetes 1.01.30
Excellus BlueCross BlueShield medical policy 1.01.30 expanded its criteria for insulin pump requests to include members who use continuous glucose monitoring rather than finger sticks. The December 18, 2025 annual review removed insulin dependency requirements and states that disposable external insulin pumps are no longer investigational. The May 22, 2025 update had changed the initial pump self-testing requirement from four times a day to three times per day, and the prior initiation requirement from two months to one month.
Aetna · Identified Nov 4, 2026Medium impact
Selected Kidney Function Tests (CPB 0775, reviewed 2026-10-28)
Aetna's Clinical Policy Bulletin 0775 (reviewed 2026-10-28) designates multiple advanced kidney function tests as experimental, investigational, or unproven, including KidneyIntelX, IntelxDKD, NaviDKD, PromarkerD, RenalVysion, RenaDx, RenaXome, GFR NMR, APOL1 genotyping, and transdermal pyrazine-based GFR measurement. Claims for these tests will be denied when billed with the specified CPT codes and ICD-10 indications listed in the policy.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Retinal Telescreening for Diabetic Retinopathy
Retinal telescreening with digital imaging and manual grading of images may be considered medically necessary as a screening technique for the detection of diabetic retinopathy. Digital retinal imaging with image interpretation by FDA-approved artificial intelligence software, such as IDX-DR or EyeArt, may be considered medically necessary for screening for diabetic retinopathy. Retinal telescreening is considered investigational for all other indications, including the monitoring and management of disease in individuals diagnosed with diabetic retinopathy.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E13.00?

There are 5 tracked policy changes affecting code E13.00, including updates from Aetna, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E13.00?

Payers that have issued tracked updates for code E13.00 include: Aetna, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E13.00 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E13.00. 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 E13.00?

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

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Remote Physiologic Monitoring (RPM) (CPB 1093, reviewed 2026-05-31)

Continuous Glucose Monitoring Systems/External Insulin Pump Therapy for Diabetes 1.01.30

Selected Kidney Function Tests (CPB 0775, reviewed 2026-10-28)

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

Retinal Telescreening for Diabetic Retinopathy

What insurance policy changes affect code E13.00?

Which payers have updated policy for code E13.00?

How do I get notified when code E13.00 policy changes?

Why do payers change policies for code E13.00?