What insurance policy changes affect code G25.81?

There are 6 tracked policy changes affecting code G25.81, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G25.81?

Payers that have issued tracked updates for code G25.81 include: Aetna.

How do I get notified when code G25.81 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G25.81. 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 G25.81?

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.

PAYER POLICY CHANGES

G25.81 Insurance Policy Changes

ICD-10 G25.81 is officially defined as "Restless legs syndrome." code G25.81 is referenced in 6 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G25.81 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
Intermittent Pneumatic Compression Devices (CPB 0500, reviewed 2026-07-10)
Aetna considers full-leg or half-leg home-use pneumatic compression devices medically necessary durable medical equipment for chronic venous insufficiency of the legs in members with venous stasis ulcers that have failed to heal after a 6-month trial of conservative therapy directed by the treating physician. Intermittent pneumatic compression devices for the lower extremities are considered medically necessary for members who are bedridden due to trauma, orthopedic surgery, neurosurgery or other circumstances preventing ambulation, and a single patient use device is considered not medically necessary. Aetna lists other uses as experimental, investigational or unproven, including treatment of critical limb ischemia, intermittent claudication, post-thrombotic syndrome, restless legs syndrome and intra-operative compression for reduction of venous thromboembolism in craniotomy.
Aetna · Identified Aug 18, 2026Medium impact
Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) (CPB 0330, reviewed 2026-05-20)
Aetna considers the multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) medically necessary to evaluate symptoms of narcolepsy to confirm the diagnosis, and for suspected idiopathic hypersomnia to help differentiate it from narcolepsy. A repeat MSLT or MWT is medically necessary only if the initial test was invalid or uninterpretable, was affected by extraneous circumstances or lacked study conditions, or the patient is suspected to have narcolepsy and an earlier test did not provide polygraphic confirmation. Home MSLT and single nap studies are experimental, investigational or unproven, as are these tests for other indications, including attention-deficit/hyperactivity disorder, chronic fatigue syndrome, insomnia, obstructive sleep apnea syndrome, restless leg syndrome, psychiatric hypersomnolence, and neurologic disorders other than narcolepsy such as dementia and Parkinson's disease.
Aetna · Identified Aug 16, 2026Medium impact
Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)
Feraheme, Ferrlecit, Injectafer, Monoferric and Venofer are medically necessary only for commercial members who have a contraindication, intolerance or ineffective response to the lower cost alternatives generic ferumoxytol, generic iron sucrose, generic sodium ferric gluconate and INFeD (iron dextran) for the labeled indication. Precertification is required for Feraheme, Ferrlecit, generic sodium ferric gluconate, Injectafer, Monoferric, Venofer and generic iron sucrose in applicable plan designs. Intravenous iron is considered experimental, investigational or unproven for other indications, including acute mountain sickness and anemia of inflammation, and it is contraindicated for genetic hemochromatosis or hemochromatosis secondary to iron overload.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)
Quantitative sensory testing (QST), current perception threshold (CPT) testing, voltage-actuated sensory nerve conduction threshold (VsNCT) testing, and quantitative thermal testing for early diagnosis of leprosy are considered experimental, investigational, or unproven for the uses listed in this policy, because their effectiveness or clinical value has not been established. Listed uses include evaluating fibromyalgia pain, chronic itch, chronic pelvic pain, and shoulder pain, and diagnosing restless legs syndrome and small fiber neuropathy in postural orthostatic tachycardia syndrome. CPT codes 0106T through 0110T and HCPCS code G0255 are not covered for the listed indications.
Aetna · Identified Aug 14, 2026Medium impact
Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)
Magnetic resonance spectroscopy (MRS) is considered medically necessary for specific indications in this policy, including assessing prognosis in hypoxic ischemic encephalopathy, distinguishing low grade from high grade gliomas, and distinguishing recurrent brain tumor from radiation-induced tumor necrosis. MRS is considered experimental, investigational, or unproven for all other indications listed, including breast cancer, prostate cancer, epilepsy, dementia and movement disorders, and traumatic brain injury. CPT 76390 is covered for the listed indications, and CPT codes 0609T, 0610T, 0611T and 0612T are not covered for the indications listed. The policy was last reviewed 03/26/2026.
Aetna · Identified Aug 14, 2026Medium impact
Near-Infrared (NIR) Spectroscopy (CPB 0796, reviewed 2025-11-19)
Aetna's Clinical Policy Bulletin 0796 considers near-infrared (NIR) spectroscopy experimental, investigational or unproven for a long list of indications, including monitoring cerebral perfusion during cardiac and non-cardiac surgery, use in the intensive care and neonatal intensive care settings, evaluating dementia, diagnosing mood disorders and schizophrenia, assessing pain, and treatment of restless legs syndrome. The policy also considers NIR intravascular ultrasound coronary imaging (for example the InfraReDx LipiScan IVUS Imaging System) experimental for all indications. It considers NIR spectroscopy using spatial frequency domain imaging (for example the Ox-Imager CS device) unproven for identifying and evaluating vascular tissue compromise and for all other indications, because there is a lack of clinical studies demonstrating that this approach improves clinical outcomes. Non-contact NIR spectroscopy (for example SnapshotNIR) is considered unproven for intra-operative wound assessment and all other indications because of insufficient evidence of its effectiveness.

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Intermittent Pneumatic Compression Devices (CPB 0500, reviewed 2026-07-10)

Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) (CPB 0330, reviewed 2026-05-20)

Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)

Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)

Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)

Near-Infrared (NIR) Spectroscopy (CPB 0796, reviewed 2025-11-19)

What insurance policy changes affect code G25.81?

Which payers have updated policy for code G25.81?

How do I get notified when code G25.81 policy changes?

Why do payers change policies for code G25.81?