G45.9 Insurance Policy Changes

ICD-10 G45.9 is officially defined as "Transient cerebral ischemic attack, unspecified." code G45.9 is referenced in 16 tracked payer policy changes from Independence Blue Cross, Blue Cross Blue Shield of North Dakota, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G45.9 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.
Excellus BlueCross BlueShield · Effective Dec 18, 2025Medium impact
Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries 7.01.110
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.
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 Oct 29, 2026Medium impact
Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2026-10-28)
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 · Identified Oct 22, 2026Medium impact
Ziconotide (Prialt) (CPB 0712, reviewed 2026-10-14)
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 · Identified Oct 1, 2026Medium impact
Cerebrovascular Angioplasty, Stenting, and Select Surgical Procedures (CPB 0276, reviewed 2026-09-10)
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 · Identified Aug 18, 2026Medium impact
Holter Monitors (CPB 0019, reviewed 2026-03-13)
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 · Identified Aug 15, 2026Medium impact
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)/Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) and Laryngopharyngeal Endoscopic Esthesiometer (LPEER) (CPB 0248, reviewed 2026-04-13)
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 · 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.
Aetna · Identified Aug 14, 2026Medium impact
Transcranial Doppler Ultrasonography (CPB 0353, reviewed 2026-05-22)
Aetna considers transcranial Doppler ultrasonography medically necessary for indications including assessing collateral blood flow and embolization during carotid endarterectomy, evaluating persons with suspected brain death, detecting microemboli after stroke or transient ischemic attack, evaluating giant cell arteritis, and assessing stroke risk in children aged 2 to 16 years with sickle cell anemia. Aetna considers it experimental, investigational, or unproven for all other indications, including screening for carotid artery stenosis in asymptomatic adults, managing traumatic brain injury, migraine headaches, epilepsy, and evaluating adults with sickle cell anemia. The covered CPT codes are 93886, 93888, 93890, 93892, 93893, 93896, 93897 and 93898 when selection criteria are met.
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.
Aetna · Identified Aug 18, 2026Low impact
Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (CPB 0703, reviewed 2025-11-24)
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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G45.9?

There are 16 tracked policy changes affecting code G45.9, including updates from Independence Blue Cross, Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G45.9?

Payers that have issued tracked updates for code G45.9 include: Independence Blue Cross, Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code G45.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G45.9. 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 G45.9?

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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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

Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries 7.01.110

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

Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2026-10-28)

Ziconotide (Prialt) (CPB 0712, reviewed 2026-10-14)

Cerebrovascular Angioplasty, Stenting, and Select Surgical Procedures (CPB 0276, reviewed 2026-09-10)

Holter Monitors (CPB 0019, reviewed 2026-03-13)

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)/Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) and Laryngopharyngeal Endoscopic Esthesiometer (LPEER) (CPB 0248, reviewed 2026-04-13)

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

Transcranial Doppler Ultrasonography (CPB 0353, reviewed 2026-05-22)

Extracranial Carotid Artery Stenting

Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (CPB 0703, reviewed 2025-11-24)

What insurance policy changes affect code G45.9?

Which payers have updated policy for code G45.9?

How do I get notified when code G45.9 policy changes?

Why do payers change policies for code G45.9?