ICD-10 G45.0 is officially defined as "Vertebro-basilar artery syndrome." code G45.0 is referenced in 10 tracked payer policy changes from UnitedHealthcare, Blue Cross Blue Shield of North Dakota, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G45.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
UnitedHealthcare's Medicare Advantage ambulatory electrocardiographic (AECG) monitoring policy was revised effective September 1, 2026, which has already passed. It adds a long list of ICD-10 diagnosis codes for the AECG CPT codes, revises coverage where no CMS local coverage determination exists, and says AECG monitoring with an FDA-cleared device is reasonable and necessary for arrhythmia monitoring before and after TAVR.
Blue Cross Blue Shield of North Dakota's October 22, 2026 notice for non-migrated commercial and Medicaid Expansion members lists medical policies reviewed by its Internal Medical Policy Committee on Oct. 13, 2026. The revised policies include reformatted criteria and policies with coding changes, such as procedure codes and diagnosis codes added to or removed from policies, including physical therapy covered-diagnosis lists and Category III T codes. The notice also lists tabled policies (Tumor Markers, where further research is needed) and states that benefit determinations are made based on the medical policy in effect at the time of service.
Excellus BlueCross BlueShield medical policy 7.01.110 considers carotid angioplasty with or without stenting, by transfemoral or transcarotid artery revascularization (TCAR), medically necessary for symptomatic patients with greater than 50% carotid artery stenosis who are at risk for adverse outcomes during carotid endarterectomy, and for asymptomatic patients with greater than 70% stenosis of the common or internal artery who are at similar risk. It considers other carotid indications, extracranial vertebral artery angioplasty or stenting, and intracranial angioplasty with or without stenting for intracranial atherosclerotic stenosis investigational. The current effective date is December 18, 2025, and the December 18, 2025 annual review states that policy intent is unchanged.
Aetna's Clinical Policy Bulletin 0801 states that intra-coronary hyperoxemic therapy, also called aqueous oxygen therapy, is experimental, investigational or unproven for carbon monoxide poisoning, cardiogenic shock, radio-contrast nephropathy, reperfusion microvascular ischemia in persons with acute myocardial infarction, and stroke, because the evidence is insufficient. The policy lists ICD-10 codes as not covered for the indications listed in the policy, and says there are no specific CPT or HCPCS codes for hyperoxemic therapy.
Aetna considers intrathecal ziconotide (Prialt) medically necessary for members with severe chronic pain that is intolerant of or refractory to other treatments, such as systemic analgesics, adjunctive therapies, or intrathecal morphine. Aetna considers it not medically necessary for members with a pre-existing history of psychosis, an infection at the micro-infusion injection site, uncontrolled bleeding diathesis, or spinal canal obstruction. Aetna considers intrathecal ziconotide experimental, investigational, or unproven for autism, epilepsy, Irukandji syndrome, migraines, primary lateral sclerosis, stroke and other indications, and considers the intrathecal combination of ziconotide, morphine and levobupivacaine experimental for cancer-related refractory pain.
Aetna considers angioplasty with carotid stenting medically necessary when an FDA-approved carotid stent and an FDA-approved or cleared embolic protection device are used for symptomatic carotid stenosis of at least 50% or asymptomatic stenosis of at least 70%, with duplex ultrasound as first-line evaluation, CTA or MRA confirmation when not contraindicated, and neurological assessment before and after stenting. Carotid endarterectomy is considered medically necessary for asymptomatic stenosis greater than 70% or symptomatic stenosis greater than 50%, and endovascular repair of intracranial aneurysms using stent-assisted coiling or flow diverting stents is also considered medically necessary. Intracranial angioplasty is considered medically necessary for medically refractory symptomatic delayed cerebral ischemia (cerebral vasospasm) after aneurysmal subarachnoid hemorrhage, while carotid revascularization is considered not medically necessary for members with a disabling stroke (modified Rankin scale 3 or greater), and extracranial vertebral stenting for asymptomatic stenosis, drug-eluting stents for extracranial artery stenosis, intracranial angioplasty and stenting for atherosclerotic stenosis, emergent large artery occlusion and all other indications, and permanent common carotid embolic protection devices are considered experimental, investigational or unproven.
Aetna considers Holter monitoring medically necessary for diagnostic evaluation of adult members with listed conditions, including palpitations, syncope or near syncope, unexplained dizziness, and possible or documented long QT syndrome, and for asymptomatic congenital complete atrioventricular block in pediatric patients. Holter monitoring is considered experimental, investigational, or unproven for all other indications because its effectiveness for those indications has not been established. CPT codes 93224, 93225, 93226 and 93227 are covered if the selection criteria are met.
Aetna considers both fiberoptic endoscopy and videofluoroscopy medically necessary for evaluating swallowing function, and considers FEES the preferred test over videofluoroscopy when one of the listed conditions applies, such as a need for a more conservative exam because of aspiration concerns, a need to assess swallowing status over a meal, a repeat exam to assess change, severe dysphagia, a need to visualize the larynx after intubation or surgery, or when positioning or transporting the member for fluoroscopy is problematic. Aetna considers the sensory testing component (endoscopic air pulse stimulation) of FEESST medically necessary for members with persistent dysphagia who meet the FEES criteria. Aetna considers modified barium swallow study medically necessary when it is performed by a speech-language pathologist and radiologist after dysphagia has been diagnosed and further follow-up is needed, and considers FEES for disorder of consciousness, LPEER for laryngopharyngeal mechano-sensitivity, and modified barium swallow study performed for screening experimental, investigational, or unproven.
Aetna considers external intermittent cardiac event monitors, external ECG monitoring for greater than 48 hours by continuous rhythm recording (such as the Zio Patch), mobile cardiovascular telemetry, and implantable loop recorders medically necessary when the listed criteria are met. The criteria cover syncope, lightheadedness, presyncope, palpitations and dizziness, and suspected atrial fibrillation as a cause of cryptogenic stroke, in members with a non-diagnostic Holter monitor or 48 hour telemetry or with symptoms that occur less often than daily. Aetna considers these monitors experimental, investigational, or unproven for all other indications, and it lists several handheld and self-monitoring ECG devices, including Kardia Mobile, Kardia 12L, KardiaMobile 6L, BodyGuardian, iHEART and the ViSi Mobile Monitoring System, as experimental, investigational, or unproven.
This is a historical copy of Aetna's clinical policy on thermal perfusion probes for monitoring regional cerebral blood flow (CPB 0703), last reviewed November 24, 2025 and first found by PolicyChanges in August 2026. Aetna treats the probe as experimental, investigational or unproven for acute neurological conditions, and the source gives no effective date.
Watch G45.0
Get one email when a payer policy names G45.0, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
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.