G47.35 Insurance Policy Changes

ICD-10 G47.35 is officially defined as "Congenital central alveolar hypoventilation syndrome." code G47.35 is referenced in 4 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 G47.35 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 Oct 15, 2026Medium impact
Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure - (Effective Date - 2026-10-15) 1.01.57
Excellus issued a new home non-invasive positive pressure ventilation policy effective October 15, 2026, and the criteria for BPAP devices were moved over from policy 1.01.06 Positive Airway Pressure Devices: CPAP and APAP. The policy sets medical necessity criteria for BPAP without a backup rate (E0470) and with a backup rate (E0471), and for home ventilators (E0466, E0467, E0468) in neuromuscular and thoracic restrictive disease, hypoventilation syndrome, COPD-related chronic respiratory failure, obstructive sleep apnea, central sleep apnea, and hospital discharge. It also sets rules for continuation of use, DME repair, and DME replacement.
Aetna · Identified Aug 14, 2026Medium impact
Pulse Oximetry and Capnography for Home Use (CPB 0339, reviewed 2026-05-21)
Aetna covers home pulse oximetry as durable medical equipment for members with chronic lung disease, severe cardiopulmonary disease, or neuromuscular disease involving the muscles of respiration, when the device is used to determine home oxygen liter flow for ambulation, exercise, or sleep, to monitor a person on a home ventilator, for short-term (one month) monitoring when a physician-directed change in home oxygen liter flow is needed, when weaning from home oxygen, or for interstage monitoring of children undergoing the Norwood procedure for hypoplastic left heart syndrome. Capnography (end-tidal carbon dioxide monitoring) is covered for members with congenital central alveolar hypoventilation syndrome. Home pulse oximetry is considered experimental, investigational, or unproven for asthma management, for evaluating and teaching CPAP, for maintenance or continuous monitoring other than for persons on a ventilator, for predicting the need for adenotonsillectomy in children, and when used alone as a screening or testing technique for suspected obstructive sleep apnea.
Aetna · Identified Aug 13, 2026Medium impact
Positive Pressure Ventilation (CPB 0452, reviewed 2026-07-01)
Aetna covers bilevel positive airway pressure (bilevel PAP) devices as durable medical equipment for members with restrictive thoracic disorders, severe COPD, central sleep apnea, complex sleep apnea, hypoventilation syndrome, or obstructive sleep apnea, when the medical necessity criteria for each condition are met. A bilevel PAP device with a backup rate feature is covered for these conditions only under specific criteria, and a backup rate feature has no proven value for obstructive sleep apnea. Ventilators with noninvasive interfaces are covered for severe neuromuscular disease, thoracic restrictive disease, or chronic respiratory failure from COPD where interruption or failure of respiratory support would lead to death, and noninvasive positive pressure ventilation is experimental, investigational, or unproven for asthma, pneumonia, bronchiolitis, acute lung injury and other indications not listed as covered.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Home Non-Invasive Positive Airway Pressure Devices for the Treatment of Respiratory Insufficiency and Failure
Nocturnal bilevel positive airway pressure (BPAP) with backup rate may be considered medically necessary for individuals with COPD and chronic respiratory failure who have chronic stable daytime (awake) hypercapnia with PaCO2 of 52 mmHg or higher, or daytime hypercapnia at least 2 weeks after discharge from a hospital stay for an acute exacerbation with decompensated respiratory acidosis. Bilevel positive airway pressure may also be considered medically necessary for thoracic restrictive disorders due to neuromuscular disease and for hypoventilation syndromes when the listed criteria are met. Non-invasive home mechanical ventilation may be considered medically necessary for COPD, hypoventilation syndromes and thoracic restrictive disorders due to neuromuscular disease when the listed criteria are met, and non-invasive positive airway pressure for COPD is considered investigational under all other conditions.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G47.35?

There are 4 tracked policy changes affecting code G47.35, 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 G47.35?

Payers that have issued tracked updates for code G47.35 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code G47.35 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G47.35. 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 G47.35?

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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Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure - (Effective Date - 2026-10-15) 1.01.57

Pulse Oximetry and Capnography for Home Use (CPB 0339, reviewed 2026-05-21)

Positive Pressure Ventilation (CPB 0452, reviewed 2026-07-01)

Home Non-Invasive Positive Airway Pressure Devices for the Treatment of Respiratory Insufficiency and Failure

What insurance policy changes affect code G47.35?

Which payers have updated policy for code G47.35?

How do I get notified when code G47.35 policy changes?

Why do payers change policies for code G47.35?