G45.3 Insurance Policy Changes

ICD-10 G45.3 is officially defined as "Amaurosis fugax." code G45.3 is referenced in 10 tracked payer policy changes from Independence Blue Cross, 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 G45.3 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Oct 1, 2026High impact
MA07.026s, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Independence Blue Cross updated ICD-10 diagnosis codes for Medicare Advantage AECG/MCOT monitoring policy effective 10/01/2026. Three broad cardiomyopathy and arrhythmia codes (I42.0, I42.8, I49.8) were terminated and replaced with nine more specific codes that provide granular differentiation (e.g., familial-genetic dilated cardiomyopathy, Brugada syndrome, CPVT). Billing teams must update systems to use only the new codes to avoid claim denials.
Independence Blue Cross · Effective Oct 1, 2026High impact
07.02.21s, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Independence Blue Cross updated ICD-10 diagnosis codes for AECG/MCOT monitoring policy effective 10/01/2026. Nine codes were terminated and replaced with more specific codes that better capture dilated cardiomyopathy subtypes, arrhythmogenic cardiomyopathy, and specific arrhythmia diagnoses including CPVT, Brugada syndrome, and ventricular bigeminy. Billing teams must update claim submission systems to use only the new codes to avoid claim denials.
Blue Cross Blue Shield of North Dakota · Identified Oct 24, 2026High impact
Medical Policy Updates for Non-Migrated Members
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.
Independence Blue Cross · Effective Jul 21, 2025Medium impact
07.02.21r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Independence Blue Cross updated AECG/MCOT monitoring policy (07.02.21s, effective 07/21/2025) to expand medically necessary continuous monitoring from 48 hours up to 15 days, and explicitly classify monitoring beyond 15 days as experimental/investigational and not covered. One ICD-10 code (Z09) was removed from covered diagnoses.
Independence Blue Cross · Effective Jul 21, 2025Medium impact
07.02.21r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Independence Blue Cross (IBX) has updated policy 07.02.21s to redefine coverage for continuous ambulatory electrocardiography (AECG) and mobile cardiac outpatient telemetry (MCOT) monitoring. Continuous AECG monitoring is now covered for periods up to 15 days (revised from previous criteria), while monitoring beyond 15 days is classified as experimental/investigational and not covered. Additionally, ICD-10 diagnosis code Z09 has been removed from the medically necessary list, effective July 21, 2025.
Independence Blue Cross · Effective Jul 21, 2025Medium impact
07.02.21r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Independence Blue Cross updated policy 07.02.21s to establish a maximum coverage limit of 15 days for continuous AECG/MCOT monitoring. Continuous external monitoring beyond 15 days is now classified as experimental/investigational and not covered. Additionally, ICD-10 code Z09 was removed from medically necessary diagnoses, affecting documentation requirements for follow-up encounters.
Aetna · Identified Aug 15, 2026Medium impact
Extended Ophthalmoscopy (CPB 0767, reviewed 2025-12-02)
Aetna considers extended ophthalmoscopy with a detailed retinal drawing (CPT 92201 and 92202) medically necessary for evaluation of the posterior portion of the eye after routine ophthalmoscopy for listed indications such as retinal detachment, diabetic retinopathy, macular degeneration, uncontrolled glaucoma or glaucoma suspect, and high axial length myopia of -6.00 diopters or less. It is not medically necessary when routine ophthalmoscopy showed normal clinical findings, and a repeat examination is medically necessary only when there is a change in signs, symptoms or condition for an indication that may progress. The service must add information not available from standard evaluation services or information that will demonstrably affect the treatment plan, and it is considered experimental, investigational or unproven for conditions such as optic neuritis, sickle cell disease and screening for retinoblastoma.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Event Monitors (CPB 0073, reviewed 2026-04-07)
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Ophthalmologic Techniques That Evaluate the Posterior Eye Segment for Glaucoma
Analysis of the optic nerve and retinal nerve fiber layer in individuals with glaucoma or glaucoma suspects may be considered medically necessary when using scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography. Measurement of ocular blood flow, pulsatile ocular blood flow, or blood flow velocity is considered investigational in the diagnosis and follow-up of individuals with glaucoma. The most recent update dated 08/25/2026 updated the policy description regarding devices and removed ICD-9 procedure and diagnosis codes, with policy statements unchanged.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Extracranial Carotid Artery Stenting
Carotid angioplasty with an FDA-approved carotid stent and an FDA-approved or cleared embolic protection device may be considered medically necessary for individuals with 50% to 99% stenosis (NASCET measurement), symptoms of focal cerebral ischemia (transient ischemic attack or monocular blindness) in the previous 120 days, symptom duration under 24 hours or non-disabling stroke, and an anatomic contraindication to carotid endarterectomy. Carotid angioplasty with stenting and embolic protection is investigational for other indications, including suitable carotid endarterectomy candidates and carotid artery dissection, and carotid angioplasty without stenting and embolic protection is investigational for all indications. Transcarotid artery revascularization is investigational for all indications. The 05/28/2026 revision also removed the ICD-9 procedure and diagnosis codes from the code reference.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G45.3?

There are 10 tracked policy changes affecting code G45.3, including updates from Independence Blue Cross, Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G45.3?

Payers that have issued tracked updates for code G45.3 include: Independence Blue Cross, Blue Cross Blue Shield of North Dakota, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code G45.3 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G45.3. 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 G45.3?

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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MA07.026s, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

07.02.21s, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

Medical Policy Updates for Non-Migrated Members

07.02.21r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

07.02.21r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

07.02.21r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

Extended Ophthalmoscopy (CPB 0767, reviewed 2025-12-02)

Cardiac Event Monitors (CPB 0073, reviewed 2026-04-07)

Ophthalmologic Techniques That Evaluate the Posterior Eye Segment for Glaucoma

Extracranial Carotid Artery Stenting

What insurance policy changes affect code G45.3?

Which payers have updated policy for code G45.3?

How do I get notified when code G45.3 policy changes?

Why do payers change policies for code G45.3?