What insurance policy changes affect code F06.1?

There are 3 tracked policy changes affecting code F06.1, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code F06.1?

Payers that have issued tracked updates for code F06.1 include: Aetna.

How do I get notified when code F06.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code F06.1. 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 F06.1?

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.

PAYER POLICY CHANGES

F06.1 Insurance Policy Changes

ICD-10 F06.1 is officially defined as "Catatonic disorder due to known physiological condition." code F06.1 is referenced in 3 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 F06.1 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 16, 2026Medium impact
Ketamine for the Treatment of Depression and Other Selected Indications (CPB 0938, reviewed 2025-12-30)
Aetna considers ketamine experimental, investigational, or unproven when given intramuscularly, intranasally, intravenously, orally, or subcutaneously for acute pain, central body pain, chronic pain, neuropathic pain, depression, generalized anxiety and social anxiety disorders, post-traumatic stress disorder, alcohol and substance use disorders, suicidal ideation, post-concussion syndrome, sickle cell vaso-occlusive crises, depression-associated sleep disturbances, stress-induced maladaptive behavior, and as a diagnostic test for catatonia. Ketamine-assisted therapy for the treatment of depression is also considered experimental, investigational, or unproven. The policy lists ICD-10 codes for these indications as not covered and states that no specific HCPCS code exists for ketamine or ketamine-assisted therapy.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)
Aetna considers quantitative EEG (brain mapping, also called BEAM) medically necessary only as an adjunct to traditional EEG for specified uses, including ambulatory EEG recording to facilitate later expert visual interpretation, continuous EEG monitoring by frequency-trending in the operating room or ICU, and topographic voltage and dipole analysis in pre-surgical evaluations for intractable epilepsy. Aetna considers quantitative EEG experimental, investigational or unproven for all other indications, including attention disorders, autism spectrum disorders, depression, schizophrenia, bipolar disorder, insomnia, fibromyalgia, post-traumatic stress disorder and post-concussion syndrome. The BrainScope One System (Ahead 300) is considered experimental, investigational or unproven for evaluation of concussion or traumatic brain injury.
Aetna · Identified Aug 13, 2026Medium impact
Electroconvulsive Therapy (CPB 0445, reviewed 2026-07-29)
Aetna considers electroconvulsive therapy medically necessary for members with bipolar disorder, catatonia, certain acute schizophrenic or schizoaffective disorder exacerbations, major depressive disorder, mania, severe or refractory neuroleptic malignant syndrome, or treatment-resistant schizophrenia as an adjunct to antipsychotic therapy, when the member is at least 12 years old and meets one of six listed selection criteria. Multiple monitored ECT, ultrabrief bilateral ECT and adjunctive ketamine in ECT are considered experimental, investigational or unproven, as is ECT for a long list of other indications such as dysthymic disorder, dementia-associated agitation, post-traumatic stress disorder and obsessive-compulsive disorder. CPT 00104 and 90870 are covered when the selection criteria are met, 90870 is not covered for ultrabrief bilateral ECT, and several transcranial magnetic stimulation, functional MRI, HCPCS E0732 and HCPCS J0654 codes are not covered for the indications listed in the policy.

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Ketamine for the Treatment of Depression and Other Selected Indications (CPB 0938, reviewed 2025-12-30)

Quantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)

Electroconvulsive Therapy (CPB 0445, reviewed 2026-07-29)

What insurance policy changes affect code F06.1?

Which payers have updated policy for code F06.1?

How do I get notified when code F06.1 policy changes?

Why do payers change policies for code F06.1?