G40.813 Insurance Policy Changes

ICD-10 G40.813 is officially defined as "Lennox-Gastaut syndrome, intractable, with status epilepticus." code G40.813 is referenced in 7 tracked payer policy changes from Aetna, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G40.813 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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.
Health Net · Identified Jun 20, 2026Medium impact
20-947 Medical Policies - 3rd Quarter 2020
Medical policies approved in the third quarter of 2020 may apply to CalViva Health Medi-Cal members in Fresno, Kings and Madera counties where no California DHCS policy is available. New policies cover respiratory viral panel testing, thymus transplantation and related criteria, while updated policies change criteria for services such as trigger point injections (now a maximum of four per year, down from six), sacroiliac joint fusion, sacral nerve stimulation and mechanical stretching devices. Some codes were added, moved or removed, including L8613 (removed) and L8692 (added) for bone-anchored hearing aids.
Health Net · Identified Jun 20, 2026Medium impact
20-944 Medical Policies - 3rd Quarter 2020
Medical policies approved in the third quarter of 2020 by Centene's Corporate Clinical Policy Committee and/or Health Net's Medical Advisory Council include new policies for respiratory viral panel testing and thymus transplantation, and updated criteria for services such as trigger point injections (now a maximum of four per year, down from six), sacroiliac joint fusion, sacral nerve stimulation and mechanical stretching devices. Some codes were added, moved or removed, including L8613 (removed) and L8692 (added) for bone-anchored hearing aids.
Health Net · Identified Jun 20, 2026Medium impact
20-946 Medical Policies - 3rd Quarter 2020
Medical policies approved in the third quarter of 2020 by Centene's Corporate Clinical Policy Committee and/or Health Net's Medical Advisory Council include new policies for respiratory viral panel testing and thymus transplantation, and updated criteria for services such as trigger point injections (now a maximum of four per year, down from six), sacroiliac joint fusion, sacral nerve stimulation and mechanical stretching devices. Some codes were added, moved or removed, including L8613 (removed) and L8692 (added) for bone-anchored hearing aids. For Cal MediConnect members, Medicare and Medicaid national and local policies must be applied first for primary coverage guidance.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G40.813?

There are 7 tracked policy changes affecting code G40.813, including updates from Aetna, Blue Cross & Blue Shield of Mississippi, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G40.813?

Payers that have issued tracked updates for code G40.813 include: Aetna, Blue Cross & Blue Shield of Mississippi, Health Net.

How do I get notified when code G40.813 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G40.813. 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 G40.813?

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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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

20-947 Medical Policies - 3rd Quarter 2020

20-944 Medical Policies - 3rd Quarter 2020

20-946 Medical Policies - 3rd Quarter 2020

What insurance policy changes affect code G40.813?

Which payers have updated policy for code G40.813?

How do I get notified when code G40.813 policy changes?

Why do payers change policies for code G40.813?