F33.9 Insurance Policy Changes

ICD-10 F33.9 is officially defined as "Major depressive disorder, recurrent, unspecified." code F33.9 is referenced in 17 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code F33.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
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 · Effective May 8, 2026Medium impact
Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 2026-08-20)
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 · Effective May 8, 2026Medium impact
Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 08-2026-05)
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.
Aetna · Identified Oct 28, 2026Medium impact
Motor Cortex Stimulation (CPB 0755, reviewed 2026-10-21)
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 · Identified Oct 23, 2026Medium impact
Actigraphy and Accelerometry (CPB 0710, reviewed 2026-10-15)
Aetna considers actigraphy testing (for example, Actiwatch) and accelerometry experimental, investigational, or unproven for listed uses, including diagnosing sleep disorders, diagnosing Alzheimer's disease, diagnosing hypertension, detecting seizures during sleep, and monitoring individuals with motor neuron diseases. CPT 95803 (actigraphy testing, minimum of 72 hours to 14 consecutive days of recording) and many listed ICD-10 codes, including those for depression, schizophrenia, Parkinson's disease and cerebral infarction, are not covered for the indications listed.
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 Oct 3, 2026Medium impact
Hearing Aids (CPB 0612, reviewed 2026-09-23)
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 · Identified Sep 29, 2026Medium impact
Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2026-08-21)
Aetna considers measurements of bone turnover markers for evaluating fracture risk experimental, investigational, or unproven, including bone sialoprotein, cathepsin K, osteocalcin, osteoprotegerin, P1NP, RANKL, sclerostin, and CTX-1 and NTX-1 telopeptides. Aetna also considers plasma homocysteine for evaluating fracture risk, plasma leptin for osteoporosis screening, and serum or urinary collagen crosslinks or other bone remodeling markers for the screening, diagnosis, or management of osteoporosis experimental, investigational, or unproven. Measurement of bone-specific alkaline phosphatase as a diagnostic marker for children and adolescents with secondary osteoporosis, bone turnover markers for persons receiving serotonergic anti-depressants, and collagen crosslinks for bisphosphonate-induced jaw osteonecrosis, chronic kidney disease, or osteogenesis imperfecta are also experimental, investigational, or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Motor Cortex Stimulation (CPB 0755, reviewed 2026-02-24)
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 · Identified Aug 16, 2026Medium impact
Hearing Aids (CPB 0612, reviewed 2026-03-02)
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 · 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 13, 2026Medium impact
Phototherapy for Psychiatric Disorders (CPB 0370, reviewed 2026-05-26)
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 · Identified Aug 13, 2026Medium impact
Esketamine (Spravato) (CPB 0950, reviewed 2026-02-25)
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.
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.
Aetna · Identified Aug 12, 2026Medium impact
Actigraphy and Accelerometry (CPB 0710, reviewed 2025-10-14)
Aetna considers actigraphy testing experimental, investigational, or unproven for indications including defining lithium response dimensions in bipolar disorders, detection or screening of apnea, diagnosis of Alzheimer's disease, diagnosis of hypertension, evaluation of depression, and evaluation of schizophrenia. Aetna considers accelerometry experimental, investigational, or unproven for indications including evaluating functional ability in the elderly, differential diagnosis of tremor syndromes, gait analysis in persons with hip osteoarthritis, and monitoring of physical activity during rehabilitation of persons with stroke. CPT code 95803 (actigraphy testing, recording, analysis, interpretation and report, minimum of 72 hours to 14 consecutive days of recording) and CPT codes 0533T through 0536T (continuous recording of movement disorder symptoms) 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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code F33.9?

There are 17 tracked policy changes affecting code F33.9, including updates from Blue Cross & Blue Shield of Mississippi, Aetna, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code F33.9?

Payers that have issued tracked updates for code F33.9 include: Blue Cross & Blue Shield of Mississippi, Aetna, Health Net.

How do I get notified when code F33.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code F33.9. 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 F33.9?

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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Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders

Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 2026-08-20)

Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 08-2026-05)

Motor Cortex Stimulation (CPB 0755, reviewed 2026-10-21)

Actigraphy and Accelerometry (CPB 0710, reviewed 2026-10-15)

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

Hearing Aids (CPB 0612, reviewed 2026-09-23)

Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2026-08-21)

Motor Cortex Stimulation (CPB 0755, reviewed 2026-02-24)

Hearing Aids (CPB 0612, reviewed 2026-03-02)

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

Phototherapy for Psychiatric Disorders (CPB 0370, reviewed 2026-05-26)

Esketamine (Spravato) (CPB 0950, reviewed 2026-02-25)

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

Actigraphy and Accelerometry (CPB 0710, reviewed 2025-10-14)

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 F33.9?

Which payers have updated policy for code F33.9?

How do I get notified when code F33.9 policy changes?

Why do payers change policies for code F33.9?