G30.0 Insurance Policy Changes

ICD-10 G30.0 is officially defined as "Alzheimer's disease with early onset." code G30.0 is referenced in 24 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G30.0 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, 2026High impact
Magnetic Resonance Imaging (MRI) of the Brain and Head
MRI of the brain or head is medically necessary for indications including aneurysm or arteriovenous malformation, new onset headache or acute neurologic, motor or mental status changes, known or suspected tumor or metastasis, congenital abnormality, shunt malfunction, acute or fluctuating neurologic deficits, multiple sclerosis, seizures with new onset or increasing frequency, stroke, and head trauma with specified findings. A 07/01/2026 policy update added evaluation of patients being treated with amyloid beta targeting plaque-therapy to the covered indications. MRI of the brain and head is not medically necessary for all other indications, including screening of asymptomatic patients. A 10/01/2026 code reference update added ICD-10 code QA1.792 and removed code G35.
Excellus BlueCross BlueShield · Effective May 15, 2026High impact
Positron Emission Tomography (PET) – Head Imaging 6.01.47
Effective May 15, 2026, Excellus BCBS policy 6.01.47 sets the criteria for PET head imaging, which were removed from CMP 6.01.07. The 01/22/26 update added a medically necessary statement for amyloid brain PET (CPT 78814 or 78811) when a diagnosis of MCI or dementia due to Alzheimer disease is suspected, and a statement that perfusion PET brain (CPT 78609) is not medically necessary in the evaluation of dementia. FDG brain PET (CPT 78608) is medically necessary for mild cognitive impairment, dementia evaluation, Lewy body dementia versus Alzheimer disease, suspected encephalitis, and pre-surgical evaluation of refractory seizure when all listed criteria are met, and it is not medically necessary for Parkinson disease, normal pressure hydrocephalus, or chronic traumatic encephalopathy.
Aetna · Identified Nov 3, 2026High impact
Lecanemab-irmb (Leqembi) (CPB 1026, reviewed 2026-10-29)
Aetna's clinical policy bulletin for lecanemab-irmb (Leqembi), reviewed October 29, 2026, sets commercial plan criteria for initial authorization and 12-month continuation, including staging, cognitive score thresholds, MRI monitoring for ARIA, ApoE ε4 genotype testing, and registry participation. Precertification is required by Aetna for applicable plan designs, and site-of-care utilization management applies to infusions. The practice should align prior-auth requests, documentation, and charge entry for Leqembi with these criteria.
Blue Cross & Blue Shield of Mississippi · Identified Jul 2, 2026High impact
Selected Positron Emission Tomography Technologies for Evaluation of Alzheimer Disease
Amyloid beta imaging with PET is now medically necessary to select individuals with mild cognitive impairment or mild dementia due to Alzheimer disease for amyloid beta targeting plaque-therapy, where it was previously investigational. CPT 78811 and 78814 and HCPCS A9586, Q9982 and Q9983 changed from investigational to medically necessary, ICD-10 codes G30.0-G30.9 were added, and HCPCS A4641 and A9598 were removed from the policy. Tau imaging with PET is investigational for predicting conversion to Alzheimer disease, as an adjunct to clinical diagnosis in individuals with dementia, and for selecting individuals for amyloid beta targeting plaque-therapy, and all other uses of amyloid beta imaging with PET remain investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
State and School Employees' Health Insurance Plan - Monoclonal Antibodies for Treatment of Alzheimer’s Disease
Leqembi (lecanemab-irmb) may be considered medically necessary when all initial criteria are met, for mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's disease dementia. Kisunla (donanemab-azbt) is considered not medically necessary because other formulary options are covered by the plan for treatment of Alzheimer's disease. The most recent policy revision, dated 07/01/2026, added the Leqembi medically necessary criteria, moved HCPCS J0174 from investigational to medically necessary, and added ICD-10 diagnosis codes G30.0 through G30.9.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
Monoclonal Antibodies for Treatment of Alzheimer’s Disease
Leqembi (lecanemab-irmb) may be considered medically necessary only when all initial or renewal criteria are met, and prior authorization is required. Leqembi is unproven and not medically necessary for any indication other than mild cognitive impairment due to Alzheimer's disease and mild Alzheimer's disease dementia. Kisunla (donanemab-azbt) and Leqembi IQLIK are considered not medically necessary because other formulary options are covered for Alzheimer's disease, and the policy history records this update on 07/01/2026.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
Evaluation of Biomarkers for Alzheimer Disease
Cerebrospinal fluid testing of amyloid beta peptides and tau protein is medically necessary as part of an evaluation for starting amyloid beta targeting therapy in individuals with mild cognitive impairment or mild dementia due to Alzheimer disease, a change the policy history dates to 06/15/2025. CSF neural thread protein testing for that purpose, CSF biomarker testing as an adjunct to clinical diagnosis, CSF testing for continuing amyloid beta targeting therapy, and urinary and blood biomarker testing as an adjunct to clinical diagnosis are investigational. This is and the latest change note in the policy is dated 04/01/2026.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
MA08.151e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease
Independence Blue Cross updated MA08.151e to clarify coverage for monoclonal antibodies directed against amyloid (aducanumab, lecanemab, donanemab) for Alzheimer's disease treatment. These drugs remain experimental/investigational and NOT covered except through Medicare's Coverage with Evidence Development (CED) program for patients enrolled in approved clinical studies. Billing teams must ensure claims for these medications are only submitted when patients are actively enrolled in CED clinical trials.
Humana · Effective Oct 1, 2025Medium impact
Antipsychotic Utilization Program (New)
Humana Louisiana Medicaid has implemented a new antipsychotic utilization program requiring prior authorization for antipsychotic medications prescribed to patients with documented dementia diagnoses. The program includes strict age-based criteria and specific compendia-supported indications for approval.
Aetna · Identified Oct 27, 2026Medium impact
Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2026-10-21)
Aetna Clinical Policy Bulletin 0731 (last review 10/21/2026) states that convection-enhanced delivery of drugs into brain parenchyma and low-intensity MR-guided focused ultrasound mediated disruption of the blood-brain barrier for drug delivery are experimental, investigational, or unproven because their safety and effectiveness have not been established. The policy lists CPT 0947T and several ICD-10 codes, including those for malignant neoplasm of brain, Alzheimer's disease, and epilepsy, as not covered for the indications listed in the bulletin.
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 Sep 29, 2026Medium impact
Adoptive Immunotherapy and Cellular Therapy (CPB 0641, reviewed 2026-09-25)
Aetna considers adoptive immunotherapy using tumor-infiltrating lymphocytes (TILs) or interleukin-2 activated lymphokine-activated killer (LAK) cells experimental, investigational or unproven for a long list of indications, including Alzheimer disease, esophageal, gynecologic, head and neck, hepatocellular, lung, glioblastoma, renal cell, pancreatic and other malignancies, because there is not adequate evidence that it is more beneficial than IL-2 alone. Melanoma is excluded from that list for lifileucel (Amtagvi), an FDA-approved TIL therapy. Cellular therapy (including embryonic cell, fresh cell, glandular, live cell, MAGE-A4 cell, organotherapy and xenotransplant therapy) is considered experimental, investigational or unproven for a long list of indications due to lack of adequate evidence, including angina, arthritis, diabetes, heart failure, hypertension, ischemic heart disease, ischemic stroke, motor neuron diseases, osteoarthritis and focal cartilage defects of the knee, peripheral arterial disease, and traumatic brain injury. Cancer is excluded from that list for afamitresgene autoleucel (Tecelra), an FDA-approved MAGE-A4-directed TCR T-cell therapy for synovial sarcoma. The policy also lists CAR T-cell therapy for solid tumors and virus-specific T-cell lymphocyte therapy for viral infections as experimental, investigational or unproven. HCPCS code S2107 (adoptive immunotherapy per course of treatment) and M0075 (cellular therapy) are listed as not covered for the indications in the policy.
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
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
Aducanumab-avwa (Aduhelm) (CPB 0996, reviewed 2025-12-09)
Aetna considers aducanumab-avwa (Aduhelm) medically necessary for treatment of Alzheimer's disease for commercial medical plans when the initial approval criteria are met, and considers all other indications experimental, investigational or unproven. Aduhelm requires precertification, and Aduhelm was discontinued in November 2024.
Aetna · Identified Aug 16, 2026Medium impact
Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2025-11-26)
Aetna considers convection-enhanced delivery of drugs into the brain parenchyma experimental, investigational, or unproven. Aetna also considers low-intensity MR-guided focused ultrasound (MRgFUS) mediated disruption of the blood-brain barrier for enhanced drug delivery into the brain experimental, because the safety and effectiveness of these approaches have not been established. CPT code 0947T for MRgFUS stereotactic blood-brain barrier disruption is not covered for the indications listed, and ICD-10 codes for brain malignancies, Alzheimer's disease, epilepsy and seizures are listed as not covered.
Aetna · Identified Aug 16, 2026Medium impact
Lecanemab-irmb (Leqembi) (CPB 1026, reviewed 2026-01-27)
Aetna Clinical Policy Bulletin 1026 covers lecanemab-irmb (Leqembi) for commercial medical plans, and Medicare criteria are in a separate document. Aetna considers Leqembi medically necessary for Alzheimer's disease when the member is 50 or older, or younger with an APP, PSEN1 or PSEN2 genetic mutation or other clinical documentation to support early onset AD, and has Clinical Stage 3 or Clinical Stage 4 AD with objective cognitive impairment at baseline. Baseline scores must be taken within 12 months before treatment starts: CDR-Global Score of 0.5 or 1, MMSE of 21 to 30, or MoCA of 16 or greater. Amyloid pathology must be confirmed by PET or by a lumbar puncture CSF result, and a recent brain MRI within one year before starting is required. Members with a suspected non-AD neurodegenerative cause of cognitive impairment, more than 4 cerebral microbleeds, cortical superficial siderosis, a major vascular contribution confirmed by MRI, a cerebral contusion, encephalomalacia, brain aneurysm, CNS infection or brain tumor, a TIA, stroke, uncontrolled hypertension or seizure in the past 12 months, an uncontrolled bleeding disorder, or an immunologic disorder requiring immunoglobulins, monoclonal antibodies, immunosuppressants or plasmapheresis are excluded. Continuation is covered for 12 months after the initial 7-month approval period, and again for 12 months after the initial 19 months of therapy when the member shows a positive clinical response.
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 12, 2026Medium impact
Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (CPB 0788, reviewed 2025-11-19)
Aetna considers the treatments listed in this bulletin experimental, investigational or unproven for Alzheimer's disease because their effectiveness for that indication has not been established. The list includes acupuncture, applied behavior analysis, deep brain stimulation, gene therapy, intravenous immunoglobulins, lithium, music therapy, statins, stem cell therapy, transcranial magnetic and direct current stimulation, vagus nerve stimulation, and monoclonal antibodies such as solanezumab, bapineuzumab, crenezumab and semorinemab. The CPT, HCPCS and ICD-10 codes named in the bulletin are not covered for the indications the bulletin lists, including Alzheimer's disease (ICD-10 G30.0 through G30.9).
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.
Aetna · Identified Aug 12, 2026Medium impact
Alzheimer's Disease Tests (CPB 0349, reviewed 2026-08-04)
Aetna considers lumbar puncture CSF tests medically necessary for diagnosing or managing Alzheimer's disease when criteria are met and AD is suspected in mild cognitive impairment. Covered CSF patterns are elevated phosphorylated tau and/or total tau with reduced AB42, a low AB42/AB40 ratio, an elevated P-tau/AB42 ratio, or an elevated T-tau/AB42 ratio, and brain MRI is covered for members on Aduhelm, Leqembi, or Kisunla to indicate AD within one year before starting therapy or to evaluate for amyloid-related imaging abnormalities (ARIA) before specified doses. The following are listed as experimental, investigational, or unproven for AD diagnosis or assessment: plasma amyloid beta 40 and 42, plasma tau including p-tau217, plasma glial fibrillary acidic protein, the PrecivityAD2 test, the Syn-One test, and artificial intelligence and machine learning applications.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Genetic Testing for Alzheimer Disease
Since the 06/15/2025 policy update, genetic testing for the APOE gene is considered medically necessary to guide initiation or management of an FDA-approved amyloid-beta targeting therapy in individuals with mild cognitive impairment or mild dementia associated with Alzheimer disease, where it was previously investigational. Genetic testing for the risk assessment of Alzheimer disease in asymptomatic individuals is considered investigational in all other situations. Targeted testing for a known familial variant in the PSEN or APP genes may be considered medically necessary in an asymptomatic individual when a first- or second-degree relative has a known familial variant and the results will inform reproductive decision making.
Aetna · Identified Aug 18, 2026Low impact
Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (CPB 0703, reviewed 2025-11-24)
This is a historical copy of Aetna's clinical policy on thermal perfusion probes for monitoring regional cerebral blood flow (CPB 0703), last reviewed November 24, 2025 and first found by PolicyChanges in August 2026. Aetna treats the probe as experimental, investigational or unproven for acute neurological conditions, and the source gives no effective date.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA08.151d, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease
Independence Blue Cross Medicare Advantage policy MA08.151d for amyloid-directed monoclonal antibodies (aducanumab, lecanemab, donanemab) has been superseded by version MA08.151e. The policy reiterates that these drugs remain experimental/investigational and NOT covered except through CMS Coverage with Evidence Development (CED) programs for Medicare Advantage members enrolled in approved clinical trials. A new HCPCS code (J0175 for donanemab-azbt) was added in July 2024, and FDA approval of donanemab (Kisunla) in July 2024 is documented.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G30.0?

There are 24 tracked policy changes affecting code G30.0, including updates from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G30.0?

Payers that have issued tracked updates for code G30.0 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Aetna, Independence Blue Cross, Humana.

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Create a free account at PolicyChanges.app and save a search filtered to code G30.0. 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 G30.0?

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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Magnetic Resonance Imaging (MRI) of the Brain and Head

Positron Emission Tomography (PET) – Head Imaging 6.01.47

Lecanemab-irmb (Leqembi) (CPB 1026, reviewed 2026-10-29)

Selected Positron Emission Tomography Technologies for Evaluation of Alzheimer Disease

State and School Employees' Health Insurance Plan - Monoclonal Antibodies for Treatment of Alzheimer’s Disease

Monoclonal Antibodies for Treatment of Alzheimer’s Disease

Evaluation of Biomarkers for Alzheimer Disease

MA08.151e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease

Antipsychotic Utilization Program (New)

Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2026-10-21)

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

Adoptive Immunotherapy and Cellular Therapy (CPB 0641, reviewed 2026-09-25)

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

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

Aducanumab-avwa (Aduhelm) (CPB 0996, reviewed 2025-12-09)

Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2025-11-26)

Lecanemab-irmb (Leqembi) (CPB 1026, reviewed 2026-01-27)

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

Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (CPB 0788, reviewed 2025-11-19)

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

Alzheimer's Disease Tests (CPB 0349, reviewed 2026-08-04)

Genetic Testing for Alzheimer Disease

Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (CPB 0703, reviewed 2025-11-24)

MA08.151d, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease

What insurance policy changes affect code G30.0?

Which payers have updated policy for code G30.0?

How do I get notified when code G30.0 policy changes?

Why do payers change policies for code G30.0?