G40.319 Insurance Policy Changes

ICD-10 G40.319 is officially defined as "Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus." code G40.319 is referenced in 6 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G40.319 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.
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.
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
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
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 G40.319?

There are 6 tracked policy changes affecting code G40.319, including updates from Excellus BlueCross BlueShield, 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 G40.319?

Payers that have issued tracked updates for code G40.319 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code G40.319 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G40.319. 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 G40.319?

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

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

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

Magnetoencephalography/Magnetic Source Imaging

Vagus Nerve Stimulation

What insurance policy changes affect code G40.319?

Which payers have updated policy for code G40.319?

How do I get notified when code G40.319 policy changes?

Why do payers change policies for code G40.319?