F33.3 Insurance Policy Changes

ICD-10 F33.3 is officially defined as "Major depressive disorder, recurrent, severe with psychotic symptoms." code F33.3 is referenced in 3 tracked payer policy changes from Aetna and Health Net. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code F33.3 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 17, 2026Medium impact
Quantitative, Functional and Connectomic Analysis of Brain MRI (CPB 0739, reviewed 2026-07-24)
Aetna considers functional MRI (fMRI) medically necessary to identify the eloquent cortex in pre-surgical evaluation of persons with brain tumors (except temporal tumors), epilepsy (except temporal neocortical epilepsy), or vascular malformations. Aetna considers connectomic analysis of multi-modal brain MRI and automated quantification of brain MRI experimental, investigational or unproven, and considers fMRI experimental, investigational or unproven for identifying the eloquent cortex in temporal neocortical epilepsy or temporal tumors and for the diagnosis, monitoring, prognosis, or surgical management of all other listed indications, including Alzheimer's disease, migraines, multiple sclerosis, schizophrenia and autism spectrum disorder. CPT 70554 and 70555 are covered if the selection criteria are met, while CPT 0865T, 0866T and 1039T are not covered for the indications listed in the policy.
Health Net · Identified Jun 20, 2026Medium impact
20-552 Earn Incentives through the Prop 56 VBP Program
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 · Identified Jun 20, 2026Medium impact
20-554 Earn Incentives through the Prop 56 VBP Program
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 F33.3

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code F33.3?

There are 3 tracked policy changes affecting code F33.3, including updates from Aetna, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code F33.3?

Payers that have issued tracked updates for code F33.3 include: Aetna, Health Net.

How do I get notified when code F33.3 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code F33.3. 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 F33.3?

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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Quantitative, Functional and Connectomic Analysis of Brain MRI (CPB 0739, reviewed 2026-07-24)

20-552 Earn Incentives through the Prop 56 VBP Program

20-554 Earn Incentives through the Prop 56 VBP Program

What insurance policy changes affect code F33.3?

Which payers have updated policy for code F33.3?

How do I get notified when code F33.3 policy changes?

Why do payers change policies for code F33.3?