G40.219 Insurance Policy Changes

ICD-10 G40.219 is officially defined as "Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus." code G40.219 is referenced in 12 tracked payer policy changes from Excellus BlueCross BlueShield, Nevada Medicaid, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G40.219 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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.
Excellus BlueCross BlueShield · Effective Aug 20, 2026Medium impact
Vagus Nerve Stimulation and Vagus Nerve Blocking Therapy 7.01.05
Implanted vagus nerve stimulation is medically appropriate as a treatment for medically refractory seizures, and it is investigational as a treatment for depression or any other non-epileptic condition. Vagus nerve stimulation implants that detect and stimulate based on increased heart rate, such as the AspireSR Model, are investigational for all indications, and vagus nerve blocking therapy is investigational as a treatment for morbid obesity. The August 20, 2026 update was an annual review with the policy intent unchanged.
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
Vagus Nerve Stimulation (CPB 0191, reviewed 2026-03-31)
Aetna's Vagus Nerve Stimulation policy (CPB 0191, reviewed March 31, 2026) considers vagus nerve electrical stimulators medically necessary durable medical equipment for focal seizures or Lennox-Gastaut syndrome in members who remain refractory to optimal anti-epileptic medications and/or surgical intervention, or who have debilitating side effects from anti-epileptic medications, and who have no history of a bilateral or left cervical vagotomy. Replacement or revision of a system is considered medically necessary when the original system met criteria, is no longer under warranty, and cannot be repaired. Integrated VNS for multiple sclerosis, psoriatic arthritis and rheumatoid arthritis, transcutaneous VNS for seizures and post-laminectomy syndrome, VNS for prevention of chronic migraine, and VNS for all other listed indications (such as depression, obesity and tinnitus) are considered experimental, investigational or unproven.
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 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.
Aetna · Identified Aug 14, 2026Medium impact
Deep Brain Stimulation (CPB 0208, reviewed 2026-03-27)
Aetna considers unilateral or bilateral deep brain stimulation medically necessary durable medical equipment for intractable tremor from Parkinson's disease or essential tremor, for severe refractory motor complications of Parkinson's disease, and for intractable primary dystonia in persons 7 years of age or older, each when the listed criteria are met. Aetna also considers bilateral stimulation of the anterior nucleus of the thalamus medically necessary for adults 18 years or older with partial onset seizures that have not responded to 3 or more antiepileptic medications. DBS for tremor from other causes and for listed indications such as Alzheimer's disease, depression, obsessive-compulsive disorder and chronic cluster headache is considered 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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G40.219?

There are 12 tracked policy changes affecting code G40.219, including updates from Excellus BlueCross BlueShield, Nevada Medicaid, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G40.219?

Payers that have issued tracked updates for code G40.219 include: Excellus BlueCross BlueShield, Nevada Medicaid, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code G40.219 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G40.219. 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 G40.219?

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.

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Positron Emission Tomography (PET) – Head Imaging 6.01.47

Vagus Nerve Stimulation and Vagus Nerve Blocking Therapy 7.01.05

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

Vagus Nerve Stimulation (CPB 0191, reviewed 2026-03-31)

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

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

Deep Brain Stimulation (CPB 0208, reviewed 2026-03-27)

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 G40.219?

Which payers have updated policy for code G40.219?

How do I get notified when code G40.219 policy changes?

Why do payers change policies for code G40.219?