ICD-10 F33.0 is officially defined as "Major depressive disorder, recurrent, mild." code F33.0 is referenced in 16 tracked payer policy changes from Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code F33.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross updated policy 08.01.80e to replace HCPCS code S0013 (Esketamine, nasal spray) with J0013 effective January 1, 2026. Billing teams must update systems to use the new J0013 code for all intranasal esketamine (Spravato) claims going forward, as the old S0013 code is no longer valid under this policy.
Independence Blue Cross reissued Policy 08.01.80e effective 01/01/2026 with a critical billing code change: HCPCS code J0013 (Esketamine nasal spray, 1 mg) replaces the deleted code S0013 for intranasal esketamine (Spravato) claims. Billing teams must immediately update systems to use J0013 for all esketamine nasal spray billing to avoid claim denials. The policy maintains coverage criteria for intravenous ketamine and intranasal esketamine for treatment-resistant depression and other specified indications.
Transcranial magnetic stimulation (TMS) using an FDA-cleared device and modality, which can include conventional TMS, deep TMS and theta burst stimulation, may be considered medically necessary as treatment of major depressive disorder when the listed criteria are met. TMS for major depressive disorder that does not meet the criteria is considered investigational, and continued TMS as maintenance therapy is considered investigational. The 09/15/2026 update added CPT codes 0889T, 0890T, 0891T and 0892T to the Covered Codes table for accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation and updated the policy guidelines regarding treatment. TMS for all other psychiatric and neurologic disorders, including bipolar disorder, schizophrenia, obsessive-compulsive disorder or migraine headaches, is considered investigational.
Aetna considers behavioral health group psychotherapy medically necessary when all of the listed criteria are met. Covered CPT codes are 90849 (multiple-family group psychotherapy) and 90853 (group psychotherapy other than multiple-family), and HCPCS C7903 covers group psychotherapy provided remotely by hospital staff licensed under applicable state law when the patient is in their home and there is no associated professional service. Group size must not exceed 12 participants.
Aetna considers behavioral health group psychotherapy medically necessary when all listed criteria are met. The criteria include a documented DSM-5-TR diagnosis, a documented treatment plan from a physician or licensed behavioral health professional within the past 90 days, and a group of no more than 12 participants led by a clinician licensed to deliver psychotherapy. Coverage may vary according to the member's benefit plan.
Independence Blue Cross Medicare Advantage updated MA08.137d to MA08.137e, adding coverage for esketamine (Spravato) nasal spray as monotherapy for treatment-resistant major depressive disorder after inadequate response to two oral antidepressants, while clarifying that ketamine for acute/chronic pain and concurrent ketamine-esketamine use remain non-covered experimental/investigational treatments. The policy became effective 12/29/2025 with a note that missing language was added on 02/10/2026.
Independence Blue Cross updated policy 08.01.80d to 08.01.80e, adding coverage for esketamine (Spravato) nasal spray as monotherapy for treatment-resistant major depressive disorder after inadequate response to two oral antidepressants, while clarifying that ketamine for acute/chronic pain, psychiatric indications beyond the specified MDD criteria, and concurrent ketamine-esketamine use remain non-covered as experimental/investigational.
Aetna's Clinical Policy Bulletin 0755 says Aetna considers motor cortex stimulation experimental, investigational, or unproven for the listed indications because its effectiveness has not been established. The listed indications include amyotrophic lateral sclerosis, autism spectrum disorder, cerebral palsy, chronic refractory pain, depression, dysphagia, Parkinson's disease, post-stroke aphasia, post-stroke hemiparesis, seizures, traumatic brain injury and obsessive compulsive disorder, and the bulletin says that list is not all-inclusive. The bulletin also lists CPT, HCPCS and ICD-10 codes that are not covered for the indications listed in the policy.
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 considers air conduction hearing aids medically necessary when hearing thresholds are 40 dB HL or greater at 500, 1000, 2000, 3000, or 4000 Hz, or 26 dB HL or greater at three of these frequencies, or when speech recognition is less than 94 percent, and bilateral air conduction hearing aids are medically necessary when these thresholds are met in each ear. Implantable and semi-implantable hearing aids are medically necessary for members with moderate-to-severe sensorineural hearing impairment who cannot tolerate an ear mold because of medical conditions such as auricular atresia or severe chronic otitis externa. Air conduction hearing aids for improvement of balance, cartilage conduction hearing aids, hearing aids and semi-implantable hearing aids for all other indications (including improvement of depression and cognitive decline in the elderly), and a free-floating piezoelectric microphone in an implantable hearing aid are considered experimental, investigational, or unproven.
Aetna's Clinical Policy Bulletin 0755 on motor cortex stimulation, with a policy history last review of 10/21/2026, considers motor cortex stimulation experimental, investigational or unproven for many indications because its effectiveness has not been established. The list includes amyotrophic lateral sclerosis, autism spectrum disorder, cerebral palsy, chronic refractory pain (such as central pain syndromes, complex regional pain syndrome, phantom limb pain, thalamic pain and trigeminal neuropathic pain), depression, dysphagia, dystonia secondary to a focal basal ganglia lesion, movement disorders, obsessive compulsive disorder, Parkinson's disease, post-stroke aphasia, post-stroke hemiparesis, seizures, traumatic brain injury, and use of motor cortex stimulation during deep brain stimulator implantation. The policy lists CPT codes 61850, 61860, 61885, 61886, 64568, 95961, 95962 and 95970 as not covered for the indications it lists.
Aetna's Clinical Policy Bulletin 0612 covers air conduction, implantable and semi-implantable hearing aids. Air conduction hearing aids are medically necessary when hearing thresholds are 40 dB HL or greater at 500, 1000, 2000, 3000, or 4000 Hz, 26 dB HL or greater at three of these frequencies, or speech recognition is less than 94 percent, and bilateral aids are medically necessary when these thresholds are met in each ear. Implantable and semi-implantable hearing aids are medically necessary for members with moderate-to-severe sensorineural hearing impairment who cannot tolerate an ear mold because of medical conditions such as auricular atresia or severe chronic otitis externa, while air conduction hearing aids for balance, cartilage conduction hearing aids, and hearing aids for all other indications, including depression and cognitive decline in the elderly, are considered experimental, investigational, or unproven.
Aetna considers a high-intensity light unit for light box therapy medically necessary durable medical equipment for seasonal affective disorder only when the member has bipolar disorder or recurrent major depression and meets DSM-V criteria for a seasonal mood disorder. Those criteria are at least 2 years of seasonal depressive episodes that completely remit when daylight increases in the spring and that substantially outnumber any non-seasonal depressive episodes. When criteria are met, the first month of rental of the high-intensity light unit is covered to see whether home phototherapy relieves the member's depression. Light box therapy is experimental, investigational, or unproven for depressive symptoms in several other populations, including nonseasonal depression, perinatal depression, Parkinson disease, cystic fibrosis, type 2 diabetes, and dementia. Phototherapy for post-stroke depression is also listed as experimental.
Aetna's Clinical Policy Bulletin 0950 covers esketamine (Spravato) nasal spray for commercial plans when the member meets its criteria, and precertification is required for all Aetna participating providers and members in applicable plan designs. For treatment-resistant depression, the member must be 18 or older with a severe major depressive disorder confirmed by a standardized rating scale, and must have had an inadequate response to two antidepressants from two different classes, each used for at least 8 weeks within the past 5 years, plus augmentation therapy or evidence-based psychotherapy during the current depressive episode. The medication must be prescribed by or in consultation with a psychiatrist and given under the direct supervision of a healthcare provider, with the member monitored for at least 2 hours after administration.
Health Net's Prop 56 Value-Based Payment (VBP) program pays add-on payments to Medi-Cal providers in Fresno, Kings and Madera counties for meeting specific measures in prenatal and postpartum care, early childhood care, chronic disease management and behavioral health integration. Payments apply to services performed on or after July 1, 2019, when submitted as a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code. Payment amounts are higher for at-risk members, for example $70 for a prenatal care visit and $105 for an at-risk prenatal care visit, and $80 for diabetes care and $120 for at-risk diabetes care.
Health Net's Prop 56 Value-Based Payment (VBP) program pays add-on payments to Medi-Cal providers in Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus and Tulare counties for meeting specific measures in prenatal and postpartum care, early childhood care, chronic disease management and behavioral health integration. Payments apply to services performed on or after July 1, 2019, when submitted as a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code. Payment amounts are higher for at-risk members, for example $70 for a prenatal care visit and $105 for an at-risk prenatal care visit, and $80 for diabetes care and $120 for at-risk diabetes care.
Watch F33.0
Get one email when a payer policy names F33.0, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
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.