F01.50 Insurance Policy Changes

ICD-10 F01.50 is officially defined as "Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety." code F01.50 is referenced in 7 tracked payer policy changes from Excellus BlueCross BlueShield, Humana, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code F01.50 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective May 15, 2026High impact
Positron Emission Tomography (PET) – Head Imaging 6.01.47
Effective May 15, 2026, Excellus BCBS policy 6.01.47 sets the criteria for PET head imaging, which were removed from CMP 6.01.07. The 01/22/26 update added a medically necessary statement for amyloid brain PET (CPT 78814 or 78811) when a diagnosis of MCI or dementia due to Alzheimer disease is suspected, and a statement that perfusion PET brain (CPT 78609) is not medically necessary in the evaluation of dementia. FDG brain PET (CPT 78608) is medically necessary for mild cognitive impairment, dementia evaluation, Lewy body dementia versus Alzheimer disease, suspected encephalitis, and pre-surgical evaluation of refractory seizure when all listed criteria are met, and it is not medically necessary for Parkinson disease, normal pressure hydrocephalus, or chronic traumatic encephalopathy.
Humana · Effective Oct 1, 2025Medium impact
Antipsychotic Utilization Program (New)
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.
Aetna · Identified Oct 5, 2026Medium impact
Infrared Therapy (CPB 0604, reviewed 2026-09-09)
Aetna considers infrared coagulation medically necessary for anal dysplasia and for members with grade I, II, or III internal hemorrhoids that are painful or persistently bleeding. Low-level infrared light therapy is considered experimental, investigational, or unproven for a long list of indications, including osteoarthritis, migraines, stroke, and diabetes mellitus, and the infrared glove is unproven for Raynaud's syndrome and all other indications. CPT 46930 is covered when selection criteria are met, while CPT 97026 and HCPCS codes A4639 and E0221 are not covered for the listed indications.
Aetna · Identified Aug 19, 2026Medium impact
Neuropsychological and Psychological Testing (CPB 0158, reviewed 2026-03-20)
Aetna covers neuropsychological testing when it is needed to assess cognitive impairment due to medical or psychiatric conditions, provided the hours or units requested do not exceed the reasonable time needed to address the clinical questions, the testing techniques are validated for the proposed diagnostic question and for the member's age and population, and the testing does not repeat measurements of the same domain. Neuropsychological testing requested for a mental health diagnosis is considered for coverage through the mental health benefit, and testing requested for a medical diagnosis such as traumatic brain injury, stroke, epilepsy or Alzheimer's disease is considered under the medical benefit. Testing performed for educational, employment, disability qualification or legal or court-related purposes is not covered, and computerized neuropsychological assessment devices such as Cognitrax are considered experimental for screening asymptomatic people and for other indications, including screening and monitoring multiple sclerosis-related cognitive impairment.
Aetna · Identified Aug 17, 2026Medium impact
Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)
Aetna considers FDA-cleared carbon isotope (13C or 14C) urea breath testing and stool antigen testing (HpSA) medically necessary for active Helicobacter pylori infection in selected persons, including adults with idiopathic thrombocytopenic purpura, persons before bariatric surgery, persons before starting proton pump inhibitor therapy for dyspepsia, and persons taking long term, low-dose aspirin or initiating chronic NSAID treatment. Nucleic acid amplification for clarithromycin resistance testing is medically necessary for selecting salvage regimens for treatment-experienced individuals with persistent H. pylori infection. H. pylori serology, the AmHPR panel, IL-1B and TNFA gene polymorphism testing, and urea breath or stool antigen testing for other indications such as stroke risk, dementia risk and screening of asymptomatic persons are considered experimental, investigational or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Laboratory Tests for Depression and Other Psychiatric Disorders (CPB 0306, reviewed 2026-06-08)
Aetna considers the dexamethasone suppression test medically necessary only when a psychiatrist requests it to differentiate psychotic depression from schizophrenia. The policy considers the test experimental, investigational, or unproven for diagnosing major depressive disorder, selecting medications for major depressive illness, and diagnosing or managing borderline personality disorder or post-traumatic stress syndrome. It also considers MindX blood tests, microRNA measurement, neutrophil-to-lymphocyte, monocyte-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosing depression, and the TruD MDS bipolar, major depressive disorder and schizophrenia tests experimental, investigational, or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Alzheimer's Disease Tests (CPB 0349, reviewed 2026-08-04)
Aetna considers lumbar puncture CSF tests medically necessary for diagnosing or managing Alzheimer's disease when criteria are met and AD is suspected in mild cognitive impairment. Covered CSF patterns are elevated phosphorylated tau and/or total tau with reduced AB42, a low AB42/AB40 ratio, an elevated P-tau/AB42 ratio, or an elevated T-tau/AB42 ratio, and brain MRI is covered for members on Aduhelm, Leqembi, or Kisunla to indicate AD within one year before starting therapy or to evaluate for amyloid-related imaging abnormalities (ARIA) before specified doses. The following are listed as experimental, investigational, or unproven for AD diagnosis or assessment: plasma amyloid beta 40 and 42, plasma tau including p-tau217, plasma glial fibrillary acidic protein, the PrecivityAD2 test, the Syn-One test, and artificial intelligence and machine learning applications.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code F01.50?

There are 7 tracked policy changes affecting code F01.50, including updates from Excellus BlueCross BlueShield, Humana, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code F01.50?

Payers that have issued tracked updates for code F01.50 include: Excellus BlueCross BlueShield, Humana, Aetna.

How do I get notified when code F01.50 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code F01.50. 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 F01.50?

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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Positron Emission Tomography (PET) – Head Imaging 6.01.47

Antipsychotic Utilization Program (New)

Infrared Therapy (CPB 0604, reviewed 2026-09-09)

Neuropsychological and Psychological Testing (CPB 0158, reviewed 2026-03-20)

Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)

Laboratory Tests for Depression and Other Psychiatric Disorders (CPB 0306, reviewed 2026-06-08)

Alzheimer's Disease Tests (CPB 0349, reviewed 2026-08-04)

What insurance policy changes affect code F01.50?

Which payers have updated policy for code F01.50?

How do I get notified when code F01.50 policy changes?

Why do payers change policies for code F01.50?