G12.21 Insurance Policy Changes

ICD-10 G12.21 is officially defined as "Amyotrophic lateral sclerosis." code G12.21 is referenced in 20 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 G12.21 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 · Effective Oct 1, 2025Medium impact
Diagnostic Uses of Sensory Evoked Potentials (SEPs)
Already effective 2025-10-01: ICD-10 diagnosis codes G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2 and G35.D for multiple sclerosis were added to the code reference, and G35 was deleted 09/30/2025. Visual evoked potentials (CPT 95930) are medically necessary for diagnosis and monitoring of multiple sclerosis, and for localizing the cause of a visual field defect not explained by lesions seen on CT or MRI. Somatosensory evoked potentials (CPT 95925, 95926, 95927 and 95938) are listed as not medically necessary for several diagnoses, including amyotrophic lateral sclerosis (G12.21) and progressive spinal muscle atrophy (G12.25).
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
Analysis of Volatile Organic Compounds (CPB 0717, reviewed 2026-10-20)
Aetna considers analysis of volatile organic compounds experimental, investigational or unproven for many indications, including detection of cancer, diagnosis of infection, diagnosis of lung disease such as asthma, diagnosis of tuberculosis and pneumonia, screening for COVID-19, and diagnosis of Parkinson's disease, because the clinical effectiveness of this technique has not been established. The policy states that there is no specific CPT code for analysis of volatile organic compounds. Its ICD-10 table lists diagnosis codes for which the analysis is not covered, and that list is not all-inclusive.
Aetna · Identified Oct 10, 2026Medium impact
Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)
Aetna considers repository corticotropin injection (Acthar Gel only) medically necessary for infantile spasms in members less than 2 years of age, and considers all other indications experimental, investigational, unproven, or not medically necessary. Precertification of Acthar Gel or Purified Cortrophin Gel is required of all Aetna participating providers and members in applicable plan designs. Purified Cortrophin Gel is considered experimental, investigational, or unproven for infantile spasms because it is not FDA-approved, nor has a compendial use, for this indication, and use of Acthar Gel in combination with Purified Cortrophin Gel is considered experimental, investigational, or unproven.
Aetna · Identified Oct 4, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)
Aetna considers autologous hematopoietic cell transplantation medically necessary for adults 18 to 69 years old with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure. This applies when active interstitial lung disease is present with a forced vital capacity or diffusing capacity of the lung for carbon monoxide below 70% of predicted, or when previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, if there are none, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic hematopoietic cell transplantation experimental, investigational, or unproven for conditions including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, myasthenia gravis, type I diabetes mellitus, age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera, and thrombotic thrombocytopenic purpura.
Aetna · Identified Aug 18, 2026Medium impact
Tofersen (Qalsody) (CPB 1031, reviewed 2026-08-10)
Aetna's Clinical Policy Bulletin 1031 covers tofersen (Qalsody) for commercial medical plans, and Medicare criteria are in a separate Medicare Part B policy. Precertification is required of Aetna participating providers and members in applicable plan designs. Aetna considers tofersen medically necessary for treating amyotrophic lateral sclerosis (ALS) in adults 18 or older who have weakness attributable to ALS, a SOD1 mutation confirmed by genetic testing, forced vital capacity (FVC) or slow vital capacity (SVC) greater than 45% of predicted value for gender, height and age, and no tracheostomy. Aetna considers continuation medically necessary when the drug treats weakness associated with ALS in members with a SOD1 gene mutation, the member has had documented clinical benefit, and invasive ventilation or tracheostomy is not required. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Testosterone Undecanoate (Aveed) Injection (CPB 0528, reviewed 2026-07-09)
Aetna's clinical policy for testosterone undecanoate (Aveed) injection covers it for commercial medical plans when it is medically necessary for primary hypogonadism or hypogonadotropic hypogonadism, or for gender dysphoria when prescribed for gender-affirming care, in each case under the listed criteria. Precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers age-related (late-onset) hypogonadism an exclusion for testosterone undecanoate therapy, and considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Bathroom and Toilet Equipment and Supplies (CPB 0429, reviewed 2026-07-22)
Aetna considers a commode chair medically necessary for members who are physically unable to use regular toilet facilities, including members confined to a single room, to one level of the home with no toilet on that level, or to a home with no toilet facilities. A bathing system, rehab shower chair or commode is considered medically necessary for members 12 months of age or older who need complex positioning during bathing and toileting and meet the listed criteria, while most other bathroom items such as grab bars, bath mats and hand-held showers are non-covered personal convenience items.
Aetna · Identified Aug 17, 2026Medium impact
Antibody Tests for Neurologic Diseases (CPB 0340, reviewed 2026-07-08)
Aetna considers antibody testing for neurological diseases medically necessary when applicable criteria are met, including for myasthenia gravis, Lambert-Eaton myasthenic syndrome, paraneoplastic and immune checkpoint inhibitor-associated neurologic syndromes, MOG antibody-associated disease, neuromyelitis optica spectrum disorder, and autoimmune encephalitis. Antibody testing for screening of asymptomatic individuals, and antibody testing in members without clinical features of encephalitis, are considered not medically necessary. Anti-HH3 and Ns6S testing for ALS, repeat MOG testing for monitoring MOG-positive optic neuritis, and routine neuronal antibody testing for early childhood-onset epilepsy are considered experimental, investigational, or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)
Aetna's Clinical Policy Bulletin 0606 covers hematopoietic cell transplantation for autoimmune diseases and other listed conditions. Aetna considers autologous transplant medically necessary for adults aged 18 to 69 with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure when either active interstitial lung disease with an FVC or DLCO below 70% of predicted is present, or previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, where none exist, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic transplant experimental, investigational or unproven for many autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, type 1 diabetes and myasthenia gravis, and for miscellaneous conditions such as age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera and thrombotic thrombocytopenic purpura.
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 15, 2026Medium impact
Ravulizumab-cwvz (Ultomiris) (CPB 0946, reviewed 2026-08-11)
Aetna considers ravulizumab-cwvz (Ultomiris) medically necessary for paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), generalized myasthenia gravis (gMG) and neuromyelitis optica spectrum disorder (NMOSD) when the listed criteria are met. Aetna considers concurrent use of ravulizumab-cwvz and eculizumab experimental, investigational, or unproven. Aetna considers ravulizumab-cwvz experimental, investigational, or unproven for other indications, including amyotrophic lateral sclerosis (ALS), aplastic anemia and COVID-19, and notes that this list is not all-inclusive. Precertification is required of all Aetna participating providers and members in applicable plan designs. The policy was last reviewed 08/11/2026 and lists a next review date of 05/27/2027.
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
Attended Electroencephalographic (EEG) Video Monitoring (CPB 0322, reviewed 2026-06-08)
Aetna considers attended electroencephalographic (EEG) video monitoring performed in a healthcare facility medically necessary when diagnosis remains uncertain after neurological examinations and standard EEG studies within the past 90 days, non-neurological causes such as syncope or cardiac arrhythmias have been ruled out, and documentation shows that extended ambulatory EEG monitoring as an outpatient would not be sufficient for the member's needs. Covered indications include differentiating epileptic events from psychogenic seizures, establishing the specific type of epilepsy in poorly characterized seizure types, establishing the diagnosis of epilepsy and evaluating response to treatment in children 3 years of age or younger, children with severe cognitive deficits, and older persons unable to communicate due to disability, evaluating newborns with proven or suspected acute brain injury and co-morbid encephalopathy, and identifying a seizure focus in members with intractable epilepsy who are being considered for epilepsy surgery. Monitoring longer than 7 days is medically necessary when events are so infrequent that they would likely not be detected within one week, when an extended stay is needed for care of an adverse event, or when medication adjustments require ongoing monitoring that cannot be safely performed on an outpatient basis. Once the cause of seizures and the specific type of epilepsy have been established, continued video EEG monitoring in older children and adults is considered not medically necessary. Attended EEG video monitoring for medical clearance to operate a motor vehicle is not considered medically necessary, and it is considered experimental, investigational or unproven for other indications including obstructive sleep apnea, assessment of the effectiveness of drug treatment in epilepsies, amyotrophic lateral sclerosis, cardiac arrest, chronic fatigue, coma, diagnosis of brain death, encephalopathy and headache.
Aetna · Identified Aug 13, 2026Medium impact
Pharmacogenetic and Pharmacodynamic Testing (CPB 0715, reviewed 2025-12-03)
Aetna Clinical Policy Bulletin 0715 (reviewed 2025-12-03) sets coverage rules for pharmacogenetic and pharmacodynamic testing, listing the tests it considers medically necessary for specific drugs and indications, including EGFR, BRAF, KRAS, BRCA, ALK, DPYD, CYP2C19, CYP2D6, HLA-B*1502 and HLA-B*5701 testing. It considers multi-gene pharmacogenetics panels and many other listed tests experimental, investigational or unproven, and it considers several FoundationOne, Guardant360 CDx and oncoReveal panels not medically necessary for particular indications because there is no proven advantage over targeted testing for those indications. This is so check current applicability with Aetna before relying on it.
Aetna · Identified Aug 13, 2026Medium impact
Edaravone Injection (CPB 0918, reviewed 2026-07-02)
Aetna requires precertification for edaravone (Radicava and generic formulations) injection for all participating providers and members in applicable plan designs, and the Site of Care Utilization Management Policy applies. Aetna considers edaravone medically necessary for amyotrophic lateral sclerosis (ALS) when the initial criteria are met, and for continuation of therapy when the continuation criteria are met. Aetna considers all other indications experimental, investigational, or unproven, including Alzheimer's disease, Parkinson disease, multiple sclerosis, acute ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and rheumatoid arthritis. The recommended dose is 60 mg given as an intravenous infusion over 60 minutes. The first treatment cycle is daily dosing for 14 days followed by a 14-day drug-free period, and later cycles are daily dosing for 10 days out of each 14-day period followed by a 14-day drug-free period. Historical note: promotion, distribution, and production of Radicava IV were set to end as early as April 1, 2025.
Aetna · Identified Aug 12, 2026Medium impact
Occupational Therapy (CPB 0250, reviewed 2026-05-19)
Aetna considers short-term occupational therapy medically necessary when a physician prescribes it and the member's condition can improve based on objective measures within 1 month of starting therapy, or when the therapy is needed to establish a maintenance program. Occupational therapy is considered not medically necessary once maximal therapeutic benefit has been achieved, when the condition is neither regressing nor improving, or when the member has no identifiable clinical condition. Treatments intended to improve instrumental activities of daily living, such as community living skills, home management, and leisure activities, are not covered.
Aetna · Identified Aug 12, 2026Medium impact
Antineoplaston Therapy (CPB 0240, reviewed 2026-04-13)
Aetna considers antineoplaston therapy (auto-urine therapy) experimental, investigational, or unproven because the effectiveness of these approaches has not been established. The following services associated with antineoplaston therapy are also listed as experimental, investigational, or unproven: ancillary diagnostic laboratory, x-rays, MRI or CT scans done to monitor the therapy; infusion pump and intravenous supplies for use with the infusion pump; placement of Hickman catheter; and oral antineoplaston therapy or associated physician services for administering and monitoring oral antineoplaston treatment. Antineoplaston therapy is not approved by the Food and Drug Administration (FDA) for any indication.
Aetna · Identified Aug 12, 2026Medium impact
Analysis of Volatile Organic Compounds (CPB 0717, reviewed 2025-11-25)
Aetna considers the analysis of volatile organic compounds (VOCs) experimental, investigational or unproven for the listed indications, because the clinical effectiveness of this technique has not been established. The listed indications include detection of bacteriuria, detection of cancer, diagnosis of pneumonia, diagnosis of tuberculosis, diagnosis of lung disease (e.g., asthma), diagnosis of obstructive sleep apnea, and screening for COVID-19. The list is not all-inclusive.
Independence Blue Cross · Identified Jun 19, 2026Low impact
05.00.30p, Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (APAP) and Bi-Level Devices
Independence Blue Cross reissued policy 05.00.30p on 10/29/2025 to communicate the company's continuing position on noninvasive respiratory assist devices (CPAP, APAP, and Bi-Level devices). The policy was reviewed and reissued with no substantive changes to coverage criteria, medical necessity requirements, or billing codes. The most recent update added ICD-10 code J44.89 (Other specified chronic obstructive pulmonary disease) effective 10/01/2023.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G12.21?

There are 20 tracked policy changes affecting code G12.21, including updates from Blue Cross & Blue Shield of Mississippi, Aetna, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G12.21?

Payers that have issued tracked updates for code G12.21 include: Blue Cross & Blue Shield of Mississippi, Aetna, Independence Blue Cross.

How do I get notified when code G12.21 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G12.21. 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 G12.21?

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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Diagnostic Uses of Sensory Evoked Potentials (SEPs)

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

Analysis of Volatile Organic Compounds (CPB 0717, reviewed 2026-10-20)

Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)

Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)

Tofersen (Qalsody) (CPB 1031, reviewed 2026-08-10)

Testosterone Undecanoate (Aveed) Injection (CPB 0528, reviewed 2026-07-09)

Bathroom and Toilet Equipment and Supplies (CPB 0429, reviewed 2026-07-22)

Antibody Tests for Neurologic Diseases (CPB 0340, reviewed 2026-07-08)

Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)

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

Ravulizumab-cwvz (Ultomiris) (CPB 0946, reviewed 2026-08-11)

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

Attended Electroencephalographic (EEG) Video Monitoring (CPB 0322, reviewed 2026-06-08)

Pharmacogenetic and Pharmacodynamic Testing (CPB 0715, reviewed 2025-12-03)

Edaravone Injection (CPB 0918, reviewed 2026-07-02)

Occupational Therapy (CPB 0250, reviewed 2026-05-19)

Antineoplaston Therapy (CPB 0240, reviewed 2026-04-13)

Analysis of Volatile Organic Compounds (CPB 0717, reviewed 2025-11-25)

05.00.30p, Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (APAP) and Bi-Level Devices

What insurance policy changes affect code G12.21?

Which payers have updated policy for code G12.21?

How do I get notified when code G12.21 policy changes?

Why do payers change policies for code G12.21?