ICD-10 G31.01 is officially defined as "Pick's disease." code G31.01 is referenced in 3 tracked payer policy changes from Humana and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G31.01 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
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 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 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.
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