F29 Insurance Policy Changes

ICD-10 F29 is officially defined as "Unspecified psychosis not due to a substance or known physiological condition." code F29 is referenced in 4 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 F29 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 22, 2026Medium impact
Ziconotide (Prialt) (CPB 0712, reviewed 2026-10-14)
Aetna considers intrathecal ziconotide (Prialt) medically necessary for members with severe chronic pain that is intolerant of or refractory to other treatments, such as systemic analgesics, adjunctive therapies, or intrathecal morphine. Aetna considers it not medically necessary for members with a pre-existing history of psychosis, an infection at the micro-infusion injection site, uncontrolled bleeding diathesis, or spinal canal obstruction. Aetna considers intrathecal ziconotide experimental, investigational, or unproven for autism, epilepsy, Irukandji syndrome, migraines, primary lateral sclerosis, stroke and other indications, and considers the intrathecal combination of ziconotide, morphine and levobupivacaine experimental for cancer-related refractory pain.
Aetna · Identified Aug 19, 2026Medium impact
Ziconotide (Prialt) (CPB 0712, reviewed 2026-03-11)
Intrathecal ziconotide (Prialt) is considered medically necessary for members with severe chronic pain that is intolerant of or refractory to other treatments, such as systemic analgesics, adjunctive therapies, or intrathecal morphine. It is considered not medically necessary for members with a pre-existing history of psychosis, an infection at the micro-infusion injection site, uncontrolled bleeding diathesis, or spinal canal obstruction. Use for autism, epilepsy, Irukandji syndrome, migraines, primary lateral sclerosis, and stroke is considered experimental, investigational, or unproven, as is the intrathecal combination of ziconotide, morphine, and levobupivacaine for cancer-related refractory pain.
Aetna · Identified Aug 14, 2026Medium impact
Quantitative Pupillometry/Pupillography (CPB 0879, reviewed 2025-12-29)
Aetna considers quantitative pupillometry and pupillography experimental, investigational, or unproven for all indications, including the following: intracranial pressure monitoring, pain assessment, early concussion assessment, Parkinson disease, Alzheimer's disease, heart failure, depression, prediction of outcome after cardiac arrest, and glaucoma, because its effectiveness has not been established. Chromatic pupillography is considered experimental, investigational, or unproven for detecting glaucoma, Leber congenital amaurosis, optic nerve diseases, and retinitis pigmentosa, and for evaluating Gaucher disease and hemianopia. CPT 95919 (quantitative pupillometry with physician or other qualified health care professional interpretation and report) is listed as not covered for the indications in this policy.
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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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code F29?

There are 4 tracked policy changes affecting code F29, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code F29?

Payers that have issued tracked updates for code F29 include: Aetna.

How do I get notified when code F29 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code F29. 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 F29?

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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Ziconotide (Prialt) (CPB 0712, reviewed 2026-10-14)

Ziconotide (Prialt) (CPB 0712, reviewed 2026-03-11)

Quantitative Pupillometry/Pupillography (CPB 0879, reviewed 2025-12-29)

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

What insurance policy changes affect code F29?

Which payers have updated policy for code F29?

How do I get notified when code F29 policy changes?

Why do payers change policies for code F29?