G20.C Insurance Policy Changes

ICD-10 G20.C is officially defined as "Parkinsonism, unspecified." code G20.C is referenced in 16 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island, Blue Cross Blue Shield of North Dakota, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G20.C 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 Rhode Island · Effective Sep 1, 2026High impact
Medical policy updates
Effective September 1, 2026, this comprehensive medical policy update introduces new prior authorization requirements for 29 spinal procedure CPT codes, three additional CPT codes (33285, 93228, 93229), and multiple genetic/biomarker testing codes across Medicare Advantage and/or commercial plans. Additionally, new ICD-10 diagnosis codes for Parkinson Disease chelation therapy, revised medical necessity criteria for multiple procedures, and significant reorganization of biomarker testing criteria into a centralized mandate policy will require billing system updates and provider notification.
Blue Cross Blue Shield of North Dakota · Identified Oct 24, 2026High impact
Medical Policy Updates for Non-Migrated Members
Blue Cross Blue Shield of North Dakota's October 22, 2026 notice for non-migrated commercial and Medicaid Expansion members lists medical policies reviewed by its Internal Medical Policy Committee on Oct. 13, 2026. The revised policies include reformatted criteria and policies with coding changes, such as procedure codes and diagnosis codes added to or removed from policies, including physical therapy covered-diagnosis lists and Category III T codes. The notice also lists tabled policies (Tumor Markers, where further research is needed) and states that benefit determinations are made based on the medical policy in effect at the time of service.
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 Aug 18, 2026Medium impact
Thalamotomy (CPB 0153, reviewed 2026-03-30)
Aetna considers unilateral thalamotomy medically necessary for abolishing tremor and rigidity in members with dystonia, Parkinson's disease, spasmodic torticollis, or tremor who meet all listed selection criteria, including a positive initial response to medication that later became refractory, screening by a neurologist with movement disorders expertise, and severe, incapacitating tremor where medical therapy has failed. Focused ultrasound thalamotomy is covered for severe essential tremor inadequately responsive to medical therapy, gamma knife thalamotomy is covered for severe essential tremor or for refractory disabling tremor and rigidity from Parkinson's disease, and thalamotomy is covered as a last resort for malignant pain when all listed criteria are met. Bilateral thalamotomy, focused ultrasound thalamotomy for tremor syndromes other than essential tremor, and thalamotomy for non-malignant pain are considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)
Aetna considers temsirolimus (Torisel or generic temsirolimus) medically necessary as a single agent for subsequent treatment of locally advanced, recurrent, or metastatic endometrial carcinoma, for relapsed or refractory mantle cell lymphoma, and for advanced renal cell carcinoma. It also considers it medically necessary for specified soft tissue sarcoma subtypes, for rhabdomyosarcoma (maximum 12 cycles, with cyclophosphamide and vinorelbine), and for subsequent treatment of advanced, recurrent/metastatic, or inoperable PEComa in uterine sarcoma. Aetna considers all other indications experimental, investigational, or unproven, and considers continuation of therapy medically necessary when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
Aetna · Identified Aug 18, 2026Medium impact
Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)
Aetna considers hospitalization for initiation of a ketogenic diet medically necessary for intractable seizures, including Doose syndrome and Lennox-Gastaut syndrome, when all listed selection criteria are met, and for persons with glucose transporter protein type 1 deficiency or pyruvate dehydrogenase complex deficiency. Aetna considers hospitalization for initiation of a ketogenic diet of unproven value for all other indications, including adult super-refractory status epilepticus, Alzheimer's disease, autism spectrum disorder, cancer, migraine prevention, multiple sclerosis, Parkinson's disease, schizophrenia and type 2 diabetes. Hospitalization for initiation of the Atkins diet for intractable seizures, mitochondrial diseases, or other indications is considered experimental, investigational, or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Stereotactic Radiosurgery (CPB 0083, reviewed 2026-03-11)
Aetna considers stereotactic radiosurgery (SRS) medically necessary in certain circumstances, and refers to the eviCore Healthcare Radiation Therapy Clinical Guidelines for medical necessity criteria. Cranial SRS is medically necessary for benign brain and spinal tumors, cranial arteriovenous malformations, cavernous malformations and hemangiomas, trigeminal neuralgia that has not responded to more conservative treatments, severe essential tremor not adequately responsive to standard medical therapy, disabling tremor in Parkinson's disease for patients who meet thalamotomy criteria but are not surgical candidates, and primary brain tumors and primary or secondary tumors involving the spine. For brain metastases, SRS is considered appropriate with a Karnofsky Performance Status of 40 or greater (or expected to return to 70 or greater), or an ECOG status of 3 or less (or expected to return to 2 or less), fewer than 10 metastatic lesions, and control of or expected control of extracranial disease. Stereotactic body radiation therapy is medically necessary for liver or hepatobiliary cancer stage I to II, organ-confined prostate cancer, inoperable stage I or IIA lung cancer, unresectable stage I to III pancreatic cancer, recurrent disease requiring re-irradiation, and oligometastatic breast, non-small cell lung, colorectal, renal cell, prostate, sarcoma, melanoma and head and neck cancers with 1 to 5 total metastases, and Aetna considers SRS experimental, investigational, or unproven for cluster headaches, epilepsy (except when associated with treatment of arteriovenous malformations or brain tumors), and mammographic microcalcification.
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 15, 2026Medium impact
Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)
Aetna considers CT perfusion studies of the brain medically necessary for evaluating acute stroke (less than 24 hours), including hemorrhagic stroke, subdural hemorrhage and transient ischemic attacks, for following up cerebral ischemia or infarction, for planning therapy for cervical or intracranial arterial occlusive disease, for identifying cerebral hyperperfusion after revascularization, and for evaluating the vascular status of solid tumors when MRI is degraded by susceptibility artifact. Aetna considers MRI perfusion studies medically necessary for diagnosing and following mass lesions such as glioma, for assessing acute stroke penumbra, and for assessing the hemodynamic significance of cervical or intracranial vascular stenosis and the efficacy of revascularization. Aetna considers CT perfusion experimental, investigational or unproven for indications including confirmation of brain death, differentiation of lung cancer from benign lesions, evaluation of head trauma and evaluation of cerebral vasospasm, and considers MRI perfusion unproven for indications including evaluation of traumatic brain injury, evaluation of persistent pain and prognostication of obstructive sleep apnea.
Aetna · Identified Aug 14, 2026Medium impact
Deep Brain Stimulation (CPB 0208, reviewed 2026-03-27)
Aetna considers unilateral or bilateral deep brain stimulation medically necessary durable medical equipment for intractable tremor from Parkinson's disease or essential tremor, for severe refractory motor complications of Parkinson's disease, and for intractable primary dystonia in persons 7 years of age or older, each when the listed criteria are met. Aetna also considers bilateral stimulation of the anterior nucleus of the thalamus medically necessary for adults 18 years or older with partial onset seizures that have not responded to 3 or more antiepileptic medications. DBS for tremor from other causes and for listed indications such as Alzheimer's disease, depression, obsessive-compulsive disorder and chronic cluster headache is considered experimental, investigational, or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Autonomic Testing / Sudomotor Tests (CPB 0485, reviewed 2026-08-11)
Aetna considers autonomic testing, including quantitative sudomotor axon reflex test (QSART), silastic sweat imprint, and thermoregulatory sweat test (TST), medically necessary as a diagnostic tool for amyloid neuropathy, autoimmune autonomic ganglionopathy, diabetic autonomic neuropathy, distal small fiber neuropathy, idiopathic neuropathy, long-COVID syndrome with suspected autonomic disorder, multiple system atrophy, orthostatic hypotension, Parkinson disease, postural tachycardia syndrome, pure autonomic failure, recurrent unexplained syncope, reflex sympathetic dystrophy or causalgia, and Sjogren's syndrome. Aetna considers autonomic testing experimental, investigational, or unproven for other indications, including chronic fatigue syndrome/myalgic encephalomyelitis, concussion, predicting foot ulcers, Raynaud phenomenon, traumatic brachial plexus injury, and traumatic brain injury. Sympathetic skin response testing, EZSCAN, SudoScan, QDIRT, QPART, VitalScan Systems, and automated devices that generate their own software interpretation are considered experimental, investigational, or unproven for the uses 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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Deep Brain Stimulation
Unilateral or bilateral deep brain stimulation of the thalamus may be considered medically necessary for disabling, medically unresponsive tremor due to essential tremor or Parkinson disease, and bilateral thalamic stimulation for tremor in both upper limbs. Unilateral or bilateral stimulation of the globus pallidus or subthalamic nucleus may be considered medically necessary for Parkinson disease and for chronic, intractable primary dystonia in individuals older than 7 years. Adaptive deep brain stimulation for Parkinson disease, deep brain stimulation for other movement disorders, cluster headaches, and the other psychiatric or neurologic disorders listed in the policy are considered investigational. A 06/05/2025 update added that adaptive deep brain stimulation for Parkinson disease is considered investigational, and a 09/16/2026 update changed the description of deep brain stimulation systems and removed ICD-9 procedure and diagnosis codes from the code reference, with the policy statements unchanged.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Apomorphine
BCBSMS requires prior authorization for apomorphine. Apokyn (apomorphine) is covered for acute, intermittent treatment of 'off' episodes in patients with advanced Parkinson's disease, while Onapgo (apomorphine) for motor fluctuations in adults with advanced Parkinson's disease is considered not medically necessary when other options covered by the Plan are available. The 09/01/2025 revision changed the policy title to Apomorphine, added the Onapgo not medically necessary statement, and added that services not approved through the BCBSMS PA review process are not medically necessary; the 12/02/2025 Pharmacy & Therapeutics review updated sources.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography
Dopamine transporter imaging with SPECT using ioflupane may be considered medically necessary when used for individuals with clinically uncertain Parkinson disease or clinically uncertain dementia with Lewy bodies. Use of this imaging is investigational for all other indications. The use of DaT-SPECT for the diagnosis, management, or surveillance of Alzheimer disease is considered out of scope for this policy.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G20.C?

There are 16 tracked policy changes affecting code G20.C, including updates from Blue Cross Blue Shield of Rhode Island, Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G20.C?

Payers that have issued tracked updates for code G20.C include: Blue Cross Blue Shield of Rhode Island, Blue Cross Blue Shield of North Dakota, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code G20.C policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G20.C. 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 G20.C?

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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Medical policy updates

Medical Policy Updates for Non-Migrated Members

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

Thalamotomy (CPB 0153, reviewed 2026-03-30)

Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)

Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)

Stereotactic Radiosurgery (CPB 0083, reviewed 2026-03-11)

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

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

Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)

Deep Brain Stimulation (CPB 0208, reviewed 2026-03-27)

Autonomic Testing / Sudomotor Tests (CPB 0485, reviewed 2026-08-11)

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

Deep Brain Stimulation

Apomorphine

Dopamine Transporter Imaging with Single-Photon Emission Computed Tomography

What insurance policy changes affect code G20.C?

Which payers have updated policy for code G20.C?

How do I get notified when code G20.C policy changes?

Why do payers change policies for code G20.C?