E75.22 Insurance Policy Changes

ICD-10 E75.22 is officially defined as "Gaucher disease." code E75.22 is referenced in 8 tracked payer policy changes from UnitedHealthcare, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E75.22 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

UnitedHealthcare · Effective Dec 1, 2026Medium impact
Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease
UnitedHealthcare Community Plan of Indiana revised its Medicaid medical policy for intravenous enzyme replacement therapy for Gaucher disease, effective 2026-12-01. VPRIV, Cerezyme, and Elelyso are covered as medically necessary for type 1 Gaucher disease when the listed criteria are met, VPRIV or Cerezyme for type 3 under the listed criteria, and all three are unproven and not medically necessary for type 2, with Elelyso also unproven for type 3. The change also adds ICD-10 code E75.22 to the applicable codes.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
MA08.023d, Enzyme Replacement for the Treatment of Gaucher's Disease
Independence Blue Cross Medicare Advantage policy MA08.023d removed HCPCS code J0205 (alglucerase injection) effective 01/01/2026 because alglucerase is no longer manufactured and has been withdrawn from market. Billing teams must stop billing this code and ensure claims use only the three covered enzyme replacement therapy codes: J1786, J3060, or J3385.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
08.00.51m, Enzyme Replacement for the Treatment of Gaucher's Disease
Independence Blue Cross reissued policy 08.00.51m with a HCPCS code deletion effective 01/01/2026: J0205 (alglucerase) has been removed due to market withdrawal. The policy maintains coverage for imiglucerase (J1786), taliglucerase alfa (J3060), and velaglucerase alfa (J3385) for Type 1 and non-neuropathic Type 3 Gaucher's disease. Billing teams must stop submitting claims with the deleted code immediately.
Aetna · Identified Aug 16, 2026Medium impact
Lysosomal Storage Disorder Treatments (CPB 0442, reviewed 2026-07-08)
Aetna's commercial policy for lysosomal storage disorder treatments covers each enzyme replacement drug for the diagnoses and criteria listed, including Fabry disease, Pompe disease, Gaucher disease, MPS I, II, IVA, VI and VII, CLN2, acid sphingomyelinase deficiency, lysosomal acid lipase deficiency and alpha-mannosidosis. Lumizyme and Pombiliti are medically necessary only for members who have a contraindication, intolerance or ineffective response to Nexviazyme, and VPRIV is medically necessary only for members who have a contraindication, intolerance or ineffective response to both Cerezyme and Elelyso. Continuation of therapy is covered only for members who are responding to therapy.
Aetna · Identified Aug 13, 2026Medium impact
Pharmacogenetic and Pharmacodynamic Testing (CPB 0715, reviewed 2025-12-03)
Aetna Clinical Policy Bulletin 0715 (reviewed 2025-12-03) sets coverage rules for pharmacogenetic and pharmacodynamic testing, listing the tests it considers medically necessary for specific drugs and indications, including EGFR, BRAF, KRAS, BRCA, ALK, DPYD, CYP2C19, CYP2D6, HLA-B*1502 and HLA-B*5701 testing. It considers multi-gene pharmacogenetics panels and many other listed tests experimental, investigational or unproven, and it considers several FoundationOne, Guardant360 CDx and oncoReveal panels not medically necessary for particular indications because there is no proven advantage over targeted testing for those indications. This is so check current applicability with Aetna before relying on it.
Aetna · Identified Aug 13, 2026Medium impact
Pediatric Intensive Feeding Programs (CPB 0809, reviewed 2025-12-11)
Aetna considers professional services for pediatric intensive feeding programs medically necessary for infants and children with complex feeding and swallowing disorders when an interdisciplinary team provides the care and every listed condition is met. Those conditions include behavior problems interfering with feeding, a documented diagnosis-specific treatment plan with estimated length of treatment, medical causes of failure to thrive treated without resolving the feeding problem, physician coordination and oversight, one of the listed feeding problems, and no response to initial treatment by a single discipline over a 2-month period. Other indications, such as childhood obesity and Prader-Willi syndrome, are considered experimental, investigational, or unproven, and electrical stimulation for swallowing or feeding disorders is also considered experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Cytochrome P450 Genotype-Guided Treatment Strategy
CYP2D6 genotyping is medically necessary for people with Gaucher disease being considered for eliglustat, and for people with Huntington disease being considered for tetrabenazine in a dosage greater than 50 mg per day. CYP2C9 genotyping is medically necessary for people with relapsing forms of multiple sclerosis being considered for siponimod. CYP450 genotyping for clopidogrel, codeine, efavirenz and other antiretroviral dosing, transplant immunosuppressant dosing, beta blockers, and antitubercular medications is considered investigational, as is the use of genetic testing panels that include multiple CYP450 variants. The most recent policy history entry, dated 10/01/2026, updates the policy description regarding devices and FDA labeling for eliglustat and tetrabenazine and revises the descriptions of CPT codes 0071U through 0076U.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA08.023c, Enzyme Replacement for the Treatment of Gaucher's Disease
Independence Blue Cross has reissued Medicare Advantage medical policy MA08.023c for enzyme replacement therapy (ERT) treating Gaucher's disease as part of their annual review process. The policy covers three FDA-approved medications (imiglucerase, taliglucerase alfa, and velaglucerase alfa) for confirmed Type 1 Gaucher's disease or non-neuropathic Type 3 cases when medical necessity criteria and specific dosing requirements are met. No substantive coverage changes are documented in this routine annual reissuance.

Watch E75.22

Get one email when a payer policy names E75.22, 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 E75.22?

There are 8 tracked policy changes affecting code E75.22, including updates from UnitedHealthcare, Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E75.22?

Payers that have issued tracked updates for code E75.22 include: UnitedHealthcare, Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E75.22 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E75.22. 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 E75.22?

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

Intravenous Enzyme Replacement Therapy (ERT) for Gaucher Disease

MA08.023d, Enzyme Replacement for the Treatment of Gaucher's Disease

08.00.51m, Enzyme Replacement for the Treatment of Gaucher's Disease

Lysosomal Storage Disorder Treatments (CPB 0442, reviewed 2026-07-08)

Pharmacogenetic and Pharmacodynamic Testing (CPB 0715, reviewed 2025-12-03)

Pediatric Intensive Feeding Programs (CPB 0809, reviewed 2025-12-11)

Cytochrome P450 Genotype-Guided Treatment Strategy

MA08.023c, Enzyme Replacement for the Treatment of Gaucher's Disease

What insurance policy changes affect code E75.22?

Which payers have updated policy for code E75.22?

How do I get notified when code E75.22 policy changes?

Why do payers change policies for code E75.22?