G40.211 Insurance Policy Changes

ICD-10 G40.211 is officially defined as "Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus." code G40.211 is referenced in 9 tracked payer policy changes from Nevada Medicaid, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G40.211 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Nevada Medicaid · Effective Mar 1, 2026Medium impact
Attention Provider Types 10 (Outpatient Surgery, Hospital Based), 12 (Hospital, Outpatient), and 46 (Ambulatory Surgical Centers): Procedure Codes C1767 and C1778 Opened for Billing
Nevada Medicaid now allows billing for vagus nerve stimulation (VNS) therapy device codes C1767 and C1778 for refractory epilepsy treatment by outpatient surgery centers, hospitals, and ambulatory surgical centers. These devices will be reimbursed at 82% of acquisition cost and require prior authorization plus specific refractory epilepsy diagnosis codes.
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
Interstitial Laser Therapy (CPB 0781, reviewed 2025-08-05)
Aetna considers interstitial laser therapy medically necessary for refractory epilepsy when the criteria in CPB 0394 - Epilepsy Surgery are met. It also considers it medically necessary for persons with recurrent brain metastases, recurrent glioblastoma, or radiation necrosis who are poor surgical candidates for craniotomy and resection, where open surgery presents prohibitive surgical risk or the tumor is located at a surgically inaccessible site. Aetna considers interstitial laser therapy experimental, investigational, or unproven for many other indications, including breast tumors, liver metastases, lung cancer, prostate cancer, pancreatic cancer, thyroid nodules, tremor disorders and chronic intractable non-malignant pain.
Aetna · Identified Aug 14, 2026Medium impact
Epilepsy Surgery (CPB 0394, reviewed 2026-06-23)
Aetna covers cerebral hemispherectomy, corpus callosotomy and temporal lobectomy (including selective amygdalohippocampectomy) when the selection criteria are met, and considers them experimental, investigational or unproven when those criteria are not met. Responsive cortical stimulation for adults with intractable focal aware or focal impaired awareness seizures is covered when its listed criteria are met, and Aetna considers responsive cortical stimulation experimental for primary generalized seizures and all other indications. Deep brain stimulation for members with intractable seizures is covered when the medical necessity criteria in CPB 0208 are met. Aetna considers stereotactic radiosurgery for small-volume hypothalamic hamartomas with intractable epilepsy in children medically necessary when the hamartoma is less than 3 cm3 and the area of fusion with the hypothalamus is less than 150 mm2. Magnetic resonance-guided laser interstitial thermal therapy is an alternative to standard surgery where the epilepsy surgery criteria are met, and the Wada test is considered medically necessary. Aetna considers stereotactic radiosurgery for medial temporal lobe epilepsy, chronic pulvinar stimulation, AI-assisted localization for epileptogenic zones, subpial transection surgery, hippocampal electrical stimulation and trigeminal nerve stimulation experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Functional Magnetic Resonance Imaging of the Brain for Presurgical Mapping or Seizure Focus Localization
Functional MRI of the brain may be considered medically necessary as a complementary test in the preoperative evaluation of individuals with refractory epilepsy or brain tumors who are candidates for neurosurgery when the lesion is in close proximity to an eloquent area of the brain (for example, one controlling verbal or motor function) and testing is expected to have an important role in assessing the spatial relation between the lesion and the eloquent brain area. Functional MRI is considered investigational for all other applications. The 01/31/2025 policy update changed the title to add presurgical mapping or seizure focus localization and changed the medical policy number to L.6.01.423, with the policy statements unchanged.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy
Responsive neurostimulation may be considered medically necessary for individuals with focal epilepsy who are 18 years or older, have focal seizures with 1 or 2 well-localized seizure foci, average 3 or more disabling seizures per month over the prior 3 months, have failed 2 or more appropriate antiepileptic medications at therapeutic doses, are not candidates for focal resective epilepsy surgery, and have no contraindications to device placement. Responsive neurostimulation is considered investigational for all other indications. The policy was last reviewed on 06/06/2025 with no changes.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Magnetoencephalography/Magnetic Source Imaging
Magnetoencephalography (MEG) and magnetic source imaging (MSI) may be considered medically necessary for determining the laterality of language function as a substitute for the Wada test in patients preparing for surgery for epilepsy, brain tumors, and other indications requiring brain resection. MEG/MSI may also be considered medically necessary as part of the preoperative evaluation of patients with drug-resistant epilepsy (seizures refractory to at least two first-line anticonvulsants) when standard techniques such as MRI and EEG do not provide satisfactory localization of epileptic lesion(s). MEG/MSI is considered investigational for all other indications.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography
FDG-PET for individuals with epileptic seizures who are candidates for surgery may be considered medically necessary, and so may FDG-PET for the diagnosis of chronic osteomyelitis. The use of FDG-PET for all other miscellaneous indications is investigational, including a long list of central nervous system, pulmonary, and musculoskeletal conditions. This policy does not cover oncologic, cardiovascular, or Alzheimer disease or other dementia uses of FDG-PET, which are addressed in related policies.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Vagus Nerve Stimulation
Vagus nerve stimulation is considered medically necessary as a treatment of medically refractory seizures, defined as seizures that occur despite therapeutic levels of antiepileptic drugs, or seizures that cannot be treated with therapeutic levels of antiepileptic drugs because of intolerable adverse events of these drugs. It is considered investigational for depression, heart failure, upper-limb impairment due to stroke, essential tremor, headaches, rheumatoid arthritis, fibromyalgia, tinnitus and traumatic brain injury, including but not limited to these conditions, and transcutaneous (nonimplantable) vagus nerve stimulation devices are investigational for all indications. The 05/21/2026 update changed the policy statement to say vagus nerve stimulation is considered investigational as a treatment of rheumatoid arthritis, and removed ICD-9 procedure and diagnosis codes from the code reference.

Watch G40.211

Get one email when a payer policy names G40.211, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G40.211?

There are 9 tracked policy changes affecting code G40.211, including updates from Nevada Medicaid, Aetna, 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 G40.211?

Payers that have issued tracked updates for code G40.211 include: Nevada Medicaid, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code G40.211 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G40.211. 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 G40.211?

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

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Attention Provider Types 10 (Outpatient Surgery, Hospital Based), 12 (Hospital, Outpatient), and 46 (Ambulatory Surgical Centers): Procedure Codes C1767 and C1778 Opened for Billing

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

Interstitial Laser Therapy (CPB 0781, reviewed 2025-08-05)

Epilepsy Surgery (CPB 0394, reviewed 2026-06-23)

Functional Magnetic Resonance Imaging of the Brain for Presurgical Mapping or Seizure Focus Localization

Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy

Magnetoencephalography/Magnetic Source Imaging

Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography

Vagus Nerve Stimulation

What insurance policy changes affect code G40.211?

Which payers have updated policy for code G40.211?

How do I get notified when code G40.211 policy changes?

Why do payers change policies for code G40.211?