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G35.B0

PAYER POLICY CHANGES

G35.B0 Insurance Policy Changes

ICD-10 G35.B0 is officially defined as "Primary progressive multiple sclerosis, unspecified." code G35.B0 is referenced in 35 tracked payer policy changes from Ambetter, Blue Cross Blue Shield of North Dakota, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G35.B0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Ambetter · Effective Sep 30, 2026High impact
Effective September 30, 2026: Clinical Policies
Superior HealthPlan (including its Ambetter plans) updated six clinical medical-necessity policies effective 12:00 AM on September 30, 2026, which is already in effect as of today. The changes cover epidural steroid injections, evoked potential testing, fetal surgery in utero, hospice eligibility and recertification, and pediatric liver transplant, and they include a diagnosis code change that replaces ICD-10 G35 with a set of more specific G35 codes. The notice is an older provider bulletin dated 07/22/2026 that PolicyChanges found in August, so confirm current requirements with Superior's prior authorization department at 1-800-218-7508 before relying on specific criteria.
Blue Cross Blue Shield of North Dakota · Effective Jan 1, 2026High impact
Medical Policies Updates
The following medical policies take effect Jan. 1, 2026: new policies for Aqueous Shunts and Stents for Glaucoma, Computerized Corneal Topography, Renal Denervation System, Skin Substitutes, Supplementary Algorithm for Cardiac Magnetic Resonance Imaging, and Fibrin Sealant, along with revised policies including Patient Lifts, Biofeedback, Intensity-Modulated Radiotherapy, and Electrical Nerve Stimulation. Coding changes effective Oct. 1, 2025 added new codes E0150, A9288, L1007, and A9616 for their listed services, and many policies removed G35 from covered diagnosis codes and added G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, and G35.D. Cervical Fusions, Corneal Topography, Amniotic Membrane and Amniotic Fluid, and Bioengineered Skin and Soft Tissue Substitutes policies will be archived or retired.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
Hematopoietic Cell Transplantation for Autoimmune Diseases
A 07/31/2026 policy update changed autologous hematopoietic cell transplantation for multiple sclerosis from investigational to medically necessary when the listed criteria are met. Autologous HCT for systemic sclerosis is medically necessary when its listed criteria are met, and autologous or allogeneic HCT is investigational as a treatment of systemic lupus erythematosus, juvenile idiopathic or rheumatoid arthritis, chronic inflammatory demyelinating polyneuropathy, and type 1 diabetes.
Blue Cross Blue Shield of North Dakota · Effective Mar 17, 2026Medium impact
Pharmacy Policies Available Online
Commercial prior authorization medical drug policies have revisions effective March 17, 2026, with many policies adding the Appendix A NQTL Factor Checklist, showing the number of days allowed for authorization durations, and replacing 'coverage' with 'prior authorization validity' in the initial and renewal criteria. Clinical updates include Eylea HD for macular edema following retinal vein occlusion, Breyanzi for relapsed or refractory marginal zone lymphoma, and new appendiceal neoplasm and cancer indications with ICD-10 codes D37.3 and Z85.038. Commercial post service claim edit policies for Trogarzo have revisions effective Feb. 1, 2026.
Blue Cross Blue Shield of North Dakota · Effective Feb 10, 2026Medium impact
Pharmacy Policy Updates
Commercial prior authorization medical drug policies have revisions effective Feb. 10, 2026, including new indications such as Epkinly in combination with rituximab and lenalidomide for relapsed or refractory follicular lymphoma, Gazyva for active lupus nephritis, Darzalex SQ for high-risk smoldering multiple myeloma, and Bevacizumab for respiratory papillomatosis. Commercial post service claim edit policies for Botox, Dysport, Daxxify, Myobloc, Xeomin, Asparlas, and Besponsa have revisions effective Jan. 1, 2026, with multiple sclerosis coverage moving from G35 to G35.A through G35.D. Vyepti now covers chronic migraine with ICD-10 codes G43.E01, G43.E09, G43.E11, and G43.E19, and the Infugem policy is being retired because the manufacturer discontinued the product.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Implantable Infusion Pump
Implantable infusion pumps are considered medically necessary when used to deliver drugs with FDA approval for that route and indication for primary liver cancer, metastatic colorectal cancer limited to the liver, primary epithelial ovarian cancer, severe chronic intractable pain, severe spasticity of cerebral or spinal cord origin, and insulin-dependent or insulin-requiring diabetes not adequately controlled with intensive subcutaneous insulin therapy. Other uses, such as chemotherapy for head and neck or gastric cancer, heparin for thromboembolic disease and antibiotics for osteomyelitis, are investigational. A 10/01/2025 update added ICD-10 codes G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2 and G35.D for multiple sclerosis, and G35 was deleted 09/30/2025.
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).
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA01.008d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
Independence Blue Cross MA01.008d policy was reissued on 10/01/2025 with an ICD-10 CM code update that replaced the generic G35 (Multiple sclerosis) diagnosis code with seven new granular codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D) effective for claims processed on or after 10/01/2025. The underlying coverage criteria for anesthesia services during epidural, paravertebral facet, and sacroiliac joint injections remains unchanged—GA/MAC is not covered except for patients with documented severe comorbidities or specific medical conditions.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA07.009j, Routine Foot Care for Certain Medical Conditions
Independence Blue Cross updated ICD-10 diagnosis codes for routine foot care coverage effective 10/01/2025. Multiple sclerosis (G35) was restructured with more specific codes added to Attachment C, and Type 2 diabetes in remission (E11.A) was added to Attachment B as an eligible condition. Billing teams must update diagnosis code lists to reflect these changes for claim submission and eligibility verification.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA08.017m, Botulinum Toxin Agents
Independence Blue Cross updated MA08.017m to MA08.017n effective 10/01/2025, replacing the general ICD-10 code G35 (Multiple sclerosis) with seven more specific MS subtype codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.CD). This coding refinement affects how botulinum toxin claims for MS-related indications are diagnosed and billed. The policy maintains existing coverage for botulinum toxin agents with five HCPCS codes (J0585, J0586, J0587, J0588, J0589) across multiple clinical indications.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA05.001k, High-Frequency Chest Wall Oscillation Devices
Independence Blue Cross updated MA05.001k to MA05.001l effective 10/01/2025, replacing the generic ICD-10 code G35 (Multiple sclerosis) with eight disease-specific MS codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D). This granular coding change requires billing teams to use specific MS variant codes instead of the unspecified code when documenting medical necessity for HFCWO device coverage. No changes to coverage criteria, billing codes, or payment methodology.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA11.014h, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Independence Blue Cross updated ICD-10 diagnosis codes for MA11.014h toe nail debridement policy effective 10/01/2025. Added E11.A (Type 2 diabetes in remission) to Attachment B and replaced the generic G35 (Multiple sclerosis) code with seven new MS-specific codes (G35.A through G35.D) in Attachment C. The policy coverage criteria and reimbursement methodology remain unchanged; only diagnosis code references were updated to align with new ICD-10 CM coding standards.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA07.009j, Routine Foot Care for Certain Medical Conditions
Independence Blue Cross MA07.009j updates ICD-10 diagnosis codes for routine foot care coverage effective 10/01/2025. Multiple sclerosis (G35) was recoded with more specific subtypes added to Attachment C, and Type 2 diabetes in remission (E11.A) was added to Attachment B. Billing teams must update diagnosis code lists in their systems to ensure claims are submitted with the correct updated codes for routine foot care services.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross MA07.050n policy for EMG/NCS studies was reissued with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis code G35 was replaced with five new subcategory codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D), and three S74.21X nerve injury codes had narrative corrections (high level changed to thigh level). No changes to covered procedures, CPT codes, or medical necessity criteria occurred.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA11.014h, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Independence Blue Cross updated ICD-10 diagnosis codes effective 10/01/2025 for policy MA11.014h covering nail debridement. One code (E11.A for Type 2 diabetes in remission) was added to qualifying systemic illness criteria, seven multiple sclerosis codes (G35.A, G35.B0-B2, G35.C0-C2, G35.D) replaced the single G35 code, and the generic G35 code was deleted. These changes align with updated CMS coding standards but do not modify coverage criteria or reimbursement.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
01.00.12d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
Independence Blue Cross updated policy 01.00.12d to reflect ICD-10 CM code changes effective 10/01/2025, replacing the generic code G35 (Multiple sclerosis) with seven more specific MS diagnosis codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D). The policy's core coverage rules for anesthesia services in epidural/facet/sacroiliac joint injections remain unchanged. Billing teams must update claim submission and medical record review processes to use the new granular MS codes when documenting medical necessity for GA/MAC coverage.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
07.07.01r, Routine Foot Care for Certain Medical Conditions
Independence Blue Cross updated ICD-10 diagnosis codes for routine foot care coverage effective 10/01/2025. Multiple sclerosis (G35) was restructured with more specific codes added to Attachment C, and Type 2 diabetes in remission (E11.A) was added to Attachment B. Billing teams must update diagnosis code mappings to ensure claims are submitted with the correct qualifying conditions for routine foot care reimbursement.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
05.00.14r, High-Frequency Chest Wall Oscillation Devices
Independence Blue Cross updated policy 05.00.14r to 05.00.14s, replacing the generic ICD-10 code G35 (Multiple sclerosis) with eight more specific MS diagnosis codes effective October 1, 2025. Billing teams must update coding systems to use the new granular codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D) when submitting HFCWO device claims for MS patients.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
11.08.17l, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails
Independence Blue Cross reissued Policy 11.08.17l with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis codes were replaced with more specific subcategories (G35.A, G35.B0-B2, G35.C0-C2, G35.D), and a new Type 2 diabetes remission code (E11.A) was added. These changes affect coverage determination for mycotic and symptomatic non-mycotic hypertrophic toenail debridement in patients with qualifying systemic illnesses.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
01.00.12d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
Independence Blue Cross updated ICD-10 diagnosis codes for policy 01.00.12d effective 10/01/2025, replacing the general code G35 (Multiple sclerosis) with seven specific MS subtypes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D). The coverage policy itself remains unchanged: GA/MAC for epidural, facet, and sacroiliac joint injections remains not medically necessary except in documented clinical circumstances. Billing teams must update diagnosis code mappings to ensure claims use the new specific codes.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
07.07.01r, Routine Foot Care for Certain Medical Conditions
Independence Blue Cross updated ICD-10 diagnosis codes for routine foot care coverage effective 10/01/2025. Multiple sclerosis (G35) was restructured into specific subtypes (G35.A, G35.B0-B2, G35.C0-C2, G35.D) in Attachment C, and a new Type 2 diabetes code (E11.A) was added to Attachment B. Billing teams must update diagnosis code validation logic to ensure claims use the new specific MS codes and recognize the new diabetes remission code.
Aetna · Identified Oct 5, 2026Medium impact
Therapeutic Phlebotomy (CPB 0652, reviewed 2026-09-25)
Aetna considers therapeutic phlebotomy medically necessary for erythrocytosis of undetermined etiology with a hematocrit of 55% or higher, hemochromatosis (including hereditary hemochromatosis), individuals receiving testosterone therapy with a hematocrit of 54% or higher (or hemoglobin of 180 g/L or higher), non-alcoholic fatty liver disease with hyperferritinemia, non-hereditary hemochromatosis iron overload with elevated hepatic iron concentration, polycythemia vera, polycythemia secondary to arteriovenous fistulae, cor pulmonale or cyanotic congenital heart disease (for hematocrit greater than 60%), porphyria cutanea tarda, and sickle cell crisis. The policy lists acute gouty arthritis, chronic hepatitis C, chronic urticaria, the common cold, hyperferritinemia in alcohol liver disease, hypertension, migraines, myeloproliferative disorders without polycythemia vera, and progressive multiple sclerosis as experimental, investigational or unproven for phlebotomy treatment. CPT 99195 (phlebotomy, therapeutic, separate procedure) is covered if the selection criteria are met.
Health Net · Identified Sep 25, 2026Medium impact
26-1101m Updates to Clinical Policies – August 2026
CalViva Health (Health Net's Medi-Cal plan in California) updated seven clinical policies, with the source stating they were approved for and effective in August 2026, so those changes are already in effect. The changes add or delete diagnosis and CPT codes for urodynamic testing, genitourinary and GI pathogen panels, narrow the criteria for selective nerve root blocks and epidural steroid injections, and tighten documentation rules for applied behavior analysis services.
Health Net · Identified Sep 25, 2026Medium impact
26-1102m Updates to Clinical Policies – August 2026
Community Health Plan of Imperial Valley (a Medi-Cal plan in Imperial County, California) updated seven clinical policies, with the source stating they were approved for and effective in August 2026, so those changes are already in effect. The changes add or delete diagnosis and CPT codes for urodynamic testing, genitourinary and GI pathogen panels, narrow the criteria for selective nerve root blocks and epidural steroid injections, and tighten documentation rules for applied behavior analysis services.
Health Net · Identified Sep 25, 2026Medium impact
26-1103m Updates to Clinical Policies – August 2026
Health Net's August 2026 clinical policy update changes medical necessity criteria and code lists in several policies. The biggest change is that selective nerve root blocks are now for diagnostic purposes only, with therapeutic indications removed, and the notice also updates ICD-10 and CPT lists for urodynamic testing, GI pathogen panels, vaginitis testing and vagus nerve stimulation. The notice gives no day-level effective date beyond August 2026, so treat these changes as already in effect and check the full policies in the Provider Library.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Plasma Exchange
Plasma exchange is covered as medically necessary for listed conditions, including severe mixed cryoglobulinemia with multiple manifestations, catastrophic antiphospholipid syndrome, thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome, HELLP syndrome of pregnancy, chronic inflammatory demyelinating polyradiculoneuropathy, myasthenia gravis in crisis, and ABO-incompatible kidney transplantation. Listed investigational applications include rheumatoid arthritis, systemic lupus erythematosus, sepsis, asthma, neuromyelitis optica, and multiple sclerosis with a chronic progressive or relapsing remitting course. BCBSMS makes no payment for services that are not documented to be medically necessary.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Botulinum Toxin
Botox (onabotulinumtoxinA) is the only botulinum toxin the policy covers for non-cosmetic indications, and prior authorization is required. Dysport, Myobloc and Xeomin are currently considered not medically necessary because a formulary alternative is available. The policy was reviewed and approved on 05/26/2026, and that revision states that the use of samples will not be considered current or stable therapy and revises the maximum cumulative Botox dose for individuals treated for one or more indications.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Cytochrome P450 Genotype-Guided Treatment Strategy
CYP2D6 genotyping is medically necessary for people with Gaucher disease being considered for eliglustat, and for people with Huntington disease being considered for tetrabenazine in a dosage greater than 50 mg per day. CYP2C9 genotyping is medically necessary for people with relapsing forms of multiple sclerosis being considered for siponimod. CYP450 genotyping for clopidogrel, codeine, efavirenz and other antiretroviral dosing, transplant immunosuppressant dosing, beta blockers, and antitubercular medications is considered investigational, as is the use of genetic testing panels that include multiple CYP450 variants. The most recent policy history entry, dated 10/01/2026, updates the policy description regarding devices and FDA labeling for eliglustat and tetrabenazine and revises the descriptions of CPT codes 0071U through 0076U.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
State and School Employees' Health Insurance Plan - Multiple Sclerosis
Under the State and School Employees' Health Insurance Plan, Lemtrada (alemtuzumab), Ocrevus, Ocrevus Zunovo, Tyruko and Tysabri are medically necessary for multiple sclerosis when the listed criteria are met, and Briumvi (ublituximab-xiiy) is not covered on the State Health Plan Medical Drug Formulary. The initial criteria require the individual to be 18 years of age or older (or 10 or older, weighing at least 25 kg, for Ocrevus), a diagnosis that fits the requested drug, and a prescriber who is a specialist or has consulted with one. Approval lasts 12 months, and renewal requires prior approval through BCBSMS review and no contraindications.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Multiple Sclerosis
Prior authorization is required for the multiple sclerosis drugs in this policy. Step 1 generic preferred agents are dimethyl fumarate, fingolimod, glatiramer and teriflunomide. Step 2 brand agents require trial and failure of one Step 1 agent, except Lemtrada, which requires trial and failure of two Step 1 or Step 2 agents with one of them a Step 1 agent, and Ocrevus products, which do not require it for primary progressive MS. Bafiertam, Briumvi, Copaxone, Mavenclad, Mayzent, Ponvory, Tascenso ODT, Tecfidera and Vumerity are not covered on any BCBSMS formulary. A 10/05/2026 update combined the medical covered agents into one Preferred Agents table, added Rebif Rebidose as a Step 2 brand preferred agent, and removed the renewal clinical improvement requirement for all agents except Ampyra.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross updated ICD-10 diagnosis codes for MA07.050n (EMG/NCS policy) effective 10/01/2025. Multiple sclerosis code G35 was replaced with more specific codes (G35.A, G35.B0-B2, G35.C0-C2, G35.D), and three S74.21 nerve injury codes were corrected from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, CPT codes, or medical necessity criteria. This is a routine annual code update with no billing workflow impact.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA01.008d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
Independence Blue Cross updated ICD-10 diagnosis codes for policy MA01.008d effective 10/01/2025, replacing the general code G35 (Multiple sclerosis) with seven more specific MS-type codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D). The policy itself—which covers anesthesia services for spinal injections only in specific high-risk clinical circumstances—remains unchanged. Billing teams must update their systems to use the new granular MS codes when submitting claims for eligible anesthesia services.
Independence Blue Cross · Effective Oct 1, 2025Low impact
07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross reissued Policy 07.03.09x for EMG/NCS studies with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis codes were expanded from a single code (G35) to five specific subcategories (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D), and three S74.21X nerve injury codes had narrative corrections from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, medical necessity criteria, or billing codes.
Independence Blue Cross · Effective Oct 1, 2025Low impact
07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross reissued policy 07.03.09x on EMG/NCS studies with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis codes were granularized (G35 replaced with G35.A, G35.B0-B2, G35.C0-C2, G35.D), and three S74.21 nerve injury codes were corrected from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, CPT codes, or medical necessity criteria.
Independence Blue Cross · Effective Oct 1, 2025Low impact
11.08.17l, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails
Independence Blue Cross reissued policy 11.08.17l with no substantive coverage changes, but updated ICD-10 diagnosis codes effective 10/01/2025. Attachment B added E11.A (Type 2 diabetes in remission), Attachment C replaced generic G35 (Multiple sclerosis) with seven new MS subtype codes, and deleted the old G35 code. These are diagnostic code updates only and do not affect medical necessity criteria or billing procedures for toenail debridement.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G35.B0?

There are 35 tracked policy changes affecting code G35.B0, including updates from Ambetter, Blue Cross Blue Shield of North Dakota, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G35.B0?

Payers that have issued tracked updates for code G35.B0 include: Ambetter, Blue Cross Blue Shield of North Dakota, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross, Aetna, Health Net.

How do I get notified when code G35.B0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G35.B0. 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 G35.B0?

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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Effective September 30, 2026: Clinical Policies

Medical Policies Updates

Hematopoietic Cell Transplantation for Autoimmune Diseases

Pharmacy Policies Available Online

Pharmacy Policy Updates

Implantable Infusion Pump

Diagnostic Uses of Sensory Evoked Potentials (SEPs)

MA01.008d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management

MA07.009j, Routine Foot Care for Certain Medical Conditions

MA08.017m, Botulinum Toxin Agents

MA05.001k, High-Frequency Chest Wall Oscillation Devices

MA11.014h, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails

MA07.009j, Routine Foot Care for Certain Medical Conditions

MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

MA11.014h, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails

01.00.12d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management

07.07.01r, Routine Foot Care for Certain Medical Conditions

05.00.14r, High-Frequency Chest Wall Oscillation Devices

11.08.17l, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails

01.00.12d, Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management

07.07.01r, Routine Foot Care for Certain Medical Conditions

Therapeutic Phlebotomy (CPB 0652, reviewed 2026-09-25)

26-1101m Updates to Clinical Policies – August 2026

26-1102m Updates to Clinical Policies – August 2026

26-1103m Updates to Clinical Policies – August 2026

Plasma Exchange

Botulinum Toxin

Cytochrome P450 Genotype-Guided Treatment Strategy

State and School Employees' Health Insurance Plan - Multiple Sclerosis

Multiple Sclerosis