F90.9 Insurance Policy Changes

ICD-10 F90.9 is officially defined as "Attention-deficit hyperactivity disorder, unspecified type." code F90.9 is referenced in 8 tracked payer policy changes from Aetna and Independence Blue Cross. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code F90.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 19, 2026Medium impact
Neuropsychological and Psychological Testing (CPB 0158, reviewed 2026-03-20)
Aetna covers neuropsychological testing when it is needed to assess cognitive impairment due to medical or psychiatric conditions, provided the hours or units requested do not exceed the reasonable time needed to address the clinical questions, the testing techniques are validated for the proposed diagnostic question and for the member's age and population, and the testing does not repeat measurements of the same domain. Neuropsychological testing requested for a mental health diagnosis is considered for coverage through the mental health benefit, and testing requested for a medical diagnosis such as traumatic brain injury, stroke, epilepsy or Alzheimer's disease is considered under the medical benefit. Testing performed for educational, employment, disability qualification or legal or court-related purposes is not covered, and computerized neuropsychological assessment devices such as Cognitrax are considered experimental for screening asymptomatic people and for other indications, including screening and monitoring multiple sclerosis-related cognitive impairment.
Aetna · Identified Aug 18, 2026Medium impact
Nutritional Counseling (CPB 0049, reviewed 2026-03-10)
Aetna considers nutritional counseling a medically necessary preventive service for children and adults who are obese, and for adults who are overweight and have hypertension, dyslipidemia, impaired fasting glucose, or metabolic syndrome, when a provider recognized under the plan furnishes it. Aetna also considers counseling medically necessary for other chronic conditions where dietary adjustment has a therapeutic role, including diabetes, eating disorders, gastrointestinal disorders, hypertension, kidney disease, and seizures (ketogenic diet). Aetna considers counseling of unproven value for asthma, attention-deficit hyperactivity disorder, and chronic fatigue syndrome, and considers the NutrEval test experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Learning Disabilities, Dyslexia, and Vision (CPB 0078, reviewed 2026-03-18)
Aetna considers visual training and behavioral vision therapy for members with dyslexia or learning disabilities, ChromaGen lenses for improving learning skills in children with dyslexia, colored filtered or tinted lenses for dyslexia or learning disabilities, MoveR training, music-based interventions for individuals with learning disabilities, non-invasive brain stimulation including transcranial direct current stimulation for dyslexia, and pulsed lighting for dyslexia experimental, investigational or unproven because their effectiveness has not been established. There is no known eye or visual cause for dyslexia and learning disabilities and no effective visual treatment, and multidisciplinary evaluation and management must be based on proven procedures demonstrated by valid research. CPT codes 90867, 90868, 90869 and 92065, HCPCS codes A4541, E0733 and G0176, and the listed ICD-10 codes are not covered for the indications listed in the policy.
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 15, 2026Medium impact
Fecal Bacteriotherapy (CPB 0844, reviewed 2026-03-25)
Aetna's commercial clinical policy bulletin 0844 covers fecal bacteriotherapy. It considers fecal microbiota transplant medically necessary for Clostridium difficile infection (CDI) confirmed by a positive C. difficile toxin stool test that has recurred after at least one course of adequate antibiotic therapy. It considers a single rectal dose of Rebyota (fecal microbiota, live-jslm) medically necessary for preventing CDI when the policy's criteria are met, and it considers other listed indications, including alcoholic hepatitis, Crohn's disease, ulcerative colitis and irritable bowel syndrome, experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Sensory and Auditory Integration Therapy (CPB 0256, reviewed 2026-04-15)
Aetna considers sensory integration therapy and auditory integration therapy (also known as auditory integration training) experimental, investigational, or unproven for the management of persons with various communication, behavioral, emotional, and learning disorders and for all other indications. The effectiveness of these therapies is unproven. CPT code 97533 is not covered for the indications listed in this policy, and the listed ICD-10 codes are not covered for those indications either.
Aetna · Identified Aug 12, 2026Medium impact
Attention Deficit/Hyperactivity Disorder (CPB 0426, reviewed 2026-07-07)
Aetna Clinical Policy Bulletin 0426 sets coverage rules for attention deficit hyperactivity disorder (ADHD). It considers a medical evaluation with a complete medical history and physical examination, a complete psychiatric evaluation for adults, and laboratory evaluation (including CBC and LFT) and cardiac evaluation with an ECG if indicated medically necessary for assessment before beginning stimulant medication therapy, with blood lead level measurement for individuals with risk factors. Pharmacotherapy and behavioral modification are considered medically necessary for treatment of ADHD, and EEG or a neurological consult is medically necessary only when focal signs or clinical findings suggest a seizure disorder or a degenerative neurological condition. Neuropsychological testing is medically necessary only in neurologically complicated cases such as post head trauma or seizures, and psychological testing is not considered medically necessary for children with uncomplicated ADHD. Computerized EEG, neuroimaging, EEG theta/beta power ratio, polygenic risk score testing, acupuncture, chiropractic manipulation, cannabis and neurofeedback are listed as experimental, investigational or unproven for ADHD.
Independence Blue Cross · Identified Jul 9, 2026Low impact
07.13.01k, Orthoptic/Pleoptic Training
Independence Blue Cross reissued policy 07.13.01k on orthoptic/pleoptic training, maintaining its prior coverage position with no substantive changes to medical necessity criteria, coverage exclusions, or billing codes. The policy continues to cover orthoptic/pleoptic training for binocular vision disorders and related conditions (CPT 92065, 92066) while excluding coverage for ADHD management and exercise prisms/tinted lenses. ICD-10 codes F90.0-F90.9 (ADHD diagnoses) are explicitly listed as non-covered indications.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code F90.9?

There are 8 tracked policy changes affecting code F90.9, including updates from Aetna, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code F90.9?

Payers that have issued tracked updates for code F90.9 include: Aetna, Independence Blue Cross.

How do I get notified when code F90.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code F90.9. 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 F90.9?

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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Neuropsychological and Psychological Testing (CPB 0158, reviewed 2026-03-20)

Nutritional Counseling (CPB 0049, reviewed 2026-03-10)

Learning Disabilities, Dyslexia, and Vision (CPB 0078, reviewed 2026-03-18)

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

Fecal Bacteriotherapy (CPB 0844, reviewed 2026-03-25)

Sensory and Auditory Integration Therapy (CPB 0256, reviewed 2026-04-15)

Attention Deficit/Hyperactivity Disorder (CPB 0426, reviewed 2026-07-07)

07.13.01k, Orthoptic/Pleoptic Training

What insurance policy changes affect code F90.9?

Which payers have updated policy for code F90.9?

How do I get notified when code F90.9 policy changes?

Why do payers change policies for code F90.9?