ICD-10 G56.93 is officially defined as "Unspecified mononeuropathy of bilateral upper limbs." code G56.93 is referenced in 5 tracked payer policy changes from Health Net and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G56.93 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
CalViva Health updated multiple medical policies for Q1 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties. Key changes include new coronavirus testing guidelines, updated DME criteria, revised surgical procedure coverage, and modified prior authorization requirements for various treatments.
Health Net updated multiple medical policies in Q1 2020, including new prior authorization requirements, coverage changes for various procedures, and updated billing codes. Key changes include new coronavirus testing guidelines, revised DME criteria, and updated coverage for procedures like facet joint injections and nerve blocks.
Health Net updated multiple medical policies for Q1 2020, including new COVID-19 testing guidelines, changes to prior authorization requirements for various procedures, and updates to coverage criteria for DME, nerve blocks, transplants, and other services. Most notably, several procedures were reclassified as not medically necessary or investigational, affecting billing and coverage.
Aetna's Breast Reduction Surgery and Gynecomastia Surgery policy (CPB 0017) was reviewed on 2026-10-26, and the source does not state what changed or give a new effective date. It sets the criteria for breast reduction (CPT 19318) to be covered for symptomatic macromastia, including documented symptoms, a 3-month trial of conservative care, a resection weight that meets the Schnur body surface area table or more than 1 kg per breast, and a negative mammogram for women 50 or older, and it treats gynecomastia surgery and liposuction-only reduction as cosmetic or experimental.
Aetna considers reduction mammaplasty (CPT 19318) medically necessary for non-cosmetic indications in women age 18 or older, or once growth is complete with breast size stable for one year. For macromastia, the criteria require persistent symptoms in at least two listed body areas that are attributed to macromastia and affect daily activities for at least 1 year, documented severe breast hypertrophy in high-quality photographs, and symptoms that persist despite at least a 3-month trial of listed therapeutic measures. Gigantomastia of pregnancy is medically necessary when a listed complication is present and delivery is not imminent. Breast reduction, surgical mastectomy, or liposuction for gynecomastia is considered cosmetic, and several listed techniques are considered experimental, investigational, or unproven.
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