G89.3 Insurance Policy Changes

ICD-10 G89.3 is officially defined as "Neoplasm related pain (acute) (chronic)." code G89.3 is referenced in 24 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G89.3 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 Dec 29, 2025Medium impact
MA05.006l, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Independence Blue Cross reissued MA05.006l on 10/28/2026 to communicate its continuing position on TENS coverage; the policy itself became effective 12/29/2025 with clarified medically necessary criteria for chronic pain (other than low back pain) and revised experimental/investigational criteria. A specific criterion requiring ≥50% pain reduction has been deleted from the medically necessary section, streamlining approval requirements for TENS trial periods.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
05.00.74l, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Independence Blue Cross revised policy 05.00.74l for TENS devices effective 12/29/2025, clarifying medically necessary criteria for chronic pain (other than lower back pain) and experimental/investigational criteria. The policy REMOVED the requirement for demonstrating at least 50% pain reduction with objective evidence (e.g., decreased opioid usage, improved range of motion, VAS scores) as a continuation criterion after the initial trial period. Billing teams must update their prior authorization and claims review processes to align with the relaxed documentation requirements for continued TENS coverage.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA05.006k, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Independence Blue Cross updated MA05.006k to MA05.006l, effective 10/01/2025, replacing the broad ICD-10 code R10.2 (pelvic and perineal pain) with four more specific codes (R10.21, R10.22, R10.23, R10.24) for TENS device coverage criteria. This is an ICD-10 code maintenance update that requires billing teams to use laterality-specific and anatomically precise codes when documenting TENS eligibility for pelvic/perineal pain conditions.
Aetna · Identified Oct 28, 2026Medium impact
Motor Cortex Stimulation (CPB 0755, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0755 says Aetna considers motor cortex stimulation experimental, investigational, or unproven for the listed indications because its effectiveness has not been established. The listed indications include amyotrophic lateral sclerosis, autism spectrum disorder, cerebral palsy, chronic refractory pain, depression, dysphagia, Parkinson's disease, post-stroke aphasia, post-stroke hemiparesis, seizures, traumatic brain injury and obsessive compulsive disorder, and the bulletin says that list is not all-inclusive. The bulletin also lists CPT, HCPCS and ICD-10 codes that are not covered for the indications listed in the policy.
Aetna · Identified Oct 26, 2026Medium impact
Pulsed Radiofrequency (CPB 0735, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0735 considers pulsed radiofrequency experimental, investigational, or unproven for all indications in its list, because its effectiveness has not been established. The list includes indications such as carpal tunnel syndrome, chronic knee pain, low back pain, trigeminal neuralgia, and headache. The policy also considers the Stimpod NMS460 nerve stimulator for post-amputation pain, combined ganglion impar block and pulsed radiofrequency for pudendal neuralgia, and combined platelet-rich plasma to the Gasserian ganglion and pulsed radiofrequency for trigeminal neuralgia experimental, investigational, or unproven.
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 10, 2026Medium impact
Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)
Aetna considers radiofrequency ablation (RFA) medically necessary for indications that include colorectal cancer liver metastases, colorectal cancer lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), malignant lung masses in persons who are not candidates for surgical intervention, solitary hepatocellular carcinoma of 5 cm or less or multinodular early-stage HCC in members who are ineligible for or decline surgical resection or transplantation, renal cell carcinoma up to 4 cm in high-risk surgical candidates or in persons with renal insufficiency or a solitary kidney, and osteoid osteoma in individuals who remain symptomatic despite NSAIDs. Aetna considers RFA experimental, investigational, or unproven for combined RFA with transarterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, combined RFA and vertebral cement augmentation for spinal metastases, endoscopic ultrasound-guided RFA for aldosterone-producing adenomas, and all other indications, including curative treatment of primary or metastatic malignant neoplasms in persons able to tolerate surgical resection, biliary obstructions or strictures, renal cysts, renal angiomyolipomas, Brunner's gland hyperplasia, and unresectable localized recurrent thyroid cancers without distant metastases.
Aetna · Identified Sep 30, 2026Medium impact
Denosumab (CPB 0804, reviewed 2026-08-21)
Aetna covers Prolia and its ten listed biosimilars, and Xgeva and its nine listed biosimilars, under commercial medical plans, and precertification is required for these denosumab products in applicable plan designs. Prolia is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, bone loss in men receiving androgen deprivation therapy for prostate cancer, bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer, and inhibiting progression of bone erosion in rheumatoid arthritis, based on criteria such as fragility fracture history, pre-treatment T-score, pre-treatment FRAX probability, and prior therapy response or intolerance. Xgeva is considered medically necessary for multiple myeloma, bone metastases from solid tumors, giant cell tumor of bone, hypercalcemia of malignancy refractory to intravenous bisphosphonate therapy, and second-line therapy for osteopenia or osteoporosis in systemic mastocytosis, and continuation of Xgeva requires disease stability or improvement.
Aetna · Identified Aug 19, 2026Medium impact
Ziconotide (Prialt) (CPB 0712, reviewed 2026-03-11)
Intrathecal ziconotide (Prialt) is considered 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. It is considered 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. Use for autism, epilepsy, Irukandji syndrome, migraines, primary lateral sclerosis, and stroke is considered experimental, investigational, or unproven, as is the intrathecal combination of ziconotide, morphine, and levobupivacaine for cancer-related refractory pain.
Aetna · Identified Aug 18, 2026Medium impact
Thalamotomy (CPB 0153, reviewed 2026-03-30)
Aetna considers unilateral thalamotomy medically necessary for abolishing tremor and rigidity in members with dystonia, Parkinson's disease, spasmodic torticollis, or tremor who meet all listed selection criteria, including a positive initial response to medication that later became refractory, screening by a neurologist with movement disorders expertise, and severe, incapacitating tremor where medical therapy has failed. Focused ultrasound thalamotomy is covered for severe essential tremor inadequately responsive to medical therapy, gamma knife thalamotomy is covered for severe essential tremor or for refractory disabling tremor and rigidity from Parkinson's disease, and thalamotomy is covered as a last resort for malignant pain when all listed criteria are met. Bilateral thalamotomy, focused ultrasound thalamotomy for tremor syndromes other than essential tremor, and thalamotomy for non-malignant pain are considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Nerve Blocks (CPB 0863, reviewed 2026-07-23)
Aetna Clinical Policy Bulletin 0863 covers nerve blocks and lists which ones it considers medically necessary. Covered uses include adductor canal, femoral, fascia iliaca, erector spinae plane and transversus abdominis plane blocks for post-operative pain after specific surgeries, and celiac plexus block for cancer pain, while peripheral nerve blocks for chronic pain are covered only as an active component of a comprehensive pain management program. Blocks listed as experimental and investigational include genicular nerve blocks and peripheral nerve blocks used as the sole treatment for chronic non-malignant pain, because the effectiveness of these approaches has not been established.
Aetna · Identified Aug 17, 2026Medium impact
Motor Cortex Stimulation (CPB 0755, reviewed 2026-02-24)
Aetna's Clinical Policy Bulletin 0755 on motor cortex stimulation, with a policy history last review of 10/21/2026, considers motor cortex stimulation experimental, investigational or unproven for many indications because its effectiveness has not been established. The list includes amyotrophic lateral sclerosis, autism spectrum disorder, cerebral palsy, chronic refractory pain (such as central pain syndromes, complex regional pain syndrome, phantom limb pain, thalamic pain and trigeminal neuropathic pain), depression, dysphagia, dystonia secondary to a focal basal ganglia lesion, movement disorders, obsessive compulsive disorder, Parkinson's disease, post-stroke aphasia, post-stroke hemiparesis, seizures, traumatic brain injury, and use of motor cortex stimulation during deep brain stimulator implantation. The policy lists CPT codes 61850, 61860, 61885, 61886, 64568, 95961, 95962 and 95970 as not covered for the indications it lists.
Aetna · Identified Aug 17, 2026Medium impact
Stereotactic Cingulotomy and Capsulotomy (CPB 0288, reviewed 2026-04-16)
Aetna covers stereotactic cingulotomy as medically necessary only as a last resort to relieve pain for members with terminal cancer pain. Aetna considers stereotactic cingulotomy experimental, investigational or unproven for chronic intractable non-malignant pain (for example post-stroke pain), drug addiction, intractable seizures and psychiatric diseases. Anterior capsulotomy is considered experimental, investigational or unproven for obsessive compulsive disorder and for all other indications.
Aetna · Identified Aug 15, 2026Medium impact
Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-07-29)
Aetna considers radiofrequency ablation (RFA) medically necessary for several tumor indications, including colorectal cancer liver metastases, colorectal lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), and malignant lung masses in persons who are not candidates for surgical intervention. Solitary hepatocellular carcinoma of 5 cm or less is covered in members who are ineligible for or decline surgical resection or transplantation, and renal cell carcinoma up to 4 cm is covered in high-risk surgical candidates, persons with renal insufficiency, or persons with a solitary kidney. The policy lists curative RFA of malignant neoplasms in persons who are able to tolerate surgical resection, combined RFA with trans-arterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, and combined RFA with vertebral cement augmentation for spinal metastases as experimental, investigational, or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)
Quantitative sensory testing (QST), current perception threshold (CPT) testing, voltage-actuated sensory nerve conduction threshold (VsNCT) testing, and quantitative thermal testing for early diagnosis of leprosy are considered experimental, investigational, or unproven for the uses listed in this policy, because their effectiveness or clinical value has not been established. Listed uses include evaluating fibromyalgia pain, chronic itch, chronic pelvic pain, and shoulder pain, and diagnosing restless legs syndrome and small fiber neuropathy in postural orthostatic tachycardia syndrome. CPT codes 0106T through 0110T and HCPCS code G0255 are not covered for the listed indications.
Aetna · Identified Aug 15, 2026Medium impact
Pulsed Radiofrequency (CPB 0735, reviewed 2025-10-29)
Aetna considers pulsed radiofrequency (PRF) experimental, investigational, or unproven for all indications listed in CPB 0735, including carpal tunnel syndrome, chronic knee pain, low back pain, trigeminal neuralgia, and chronic migraine. The policy also lists the Stimpod NMS460 nerve stimulator and a wearable pulsed radiofrequency therapy device for post-amputation pain as experimental, investigational, or unproven, and it gives the same status to combined ganglion impar block and PRF for pudendal neuralgia and to combined platelet-rich plasma to the Gasserian ganglion and PRF for trigeminal neuralgia. There are no specific CPT or HCPCS codes for pulsed radiofrequency, and the policy lists ICD-10 codes that are not covered for the indications listed in the CPB.
Aetna · Identified Aug 15, 2026Medium impact
Chronic Pain Rehabilitation Programs (CPB 0237, reviewed 2026-04-23)
Aetna's Clinical Policy Bulletin 0237 sets medical necessity criteria for chronic pain rehabilitation programs. Outpatient programs are medically necessary when the member has had chronic pain for more than 3 months, has documented failure or inadequate response to standard single-modality treatment, has persistent limitations in daily or social or vocational functioning, and has a physician referral and a pre-program psychological and behavioral health evaluation. Inpatient programs for up to 21 days require refractory pain plus two or more listed intractable pain criteria, and several conditions, including prior failure of an adequate multidisciplinary program, aggressive or violent behavior, and imminent suicidal tendencies, are considered not medically necessary.
Aetna · Identified Aug 15, 2026Medium impact
Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)
Aetna considers CT perfusion studies of the brain medically necessary for evaluating acute stroke (less than 24 hours), including hemorrhagic stroke, subdural hemorrhage and transient ischemic attacks, for following up cerebral ischemia or infarction, for planning therapy for cervical or intracranial arterial occlusive disease, for identifying cerebral hyperperfusion after revascularization, and for evaluating the vascular status of solid tumors when MRI is degraded by susceptibility artifact. Aetna considers MRI perfusion studies medically necessary for diagnosing and following mass lesions such as glioma, for assessing acute stroke penumbra, and for assessing the hemodynamic significance of cervical or intracranial vascular stenosis and the efficacy of revascularization. Aetna considers CT perfusion experimental, investigational or unproven for indications including confirmation of brain death, differentiation of lung cancer from benign lesions, evaluation of head trauma and evaluation of cerebral vasospasm, and considers MRI perfusion unproven for indications including evaluation of traumatic brain injury, evaluation of persistent pain and prognostication of obstructive sleep apnea.
Aetna · Identified Aug 12, 2026Medium impact
Biofeedback (CPB 0132, reviewed 2026-07-16)
Aetna considers biofeedback medically necessary for cancer pain, chronic constipation secondary to dyssynergic defecation as confirmed by anorectal manometry, fecal incontinence, irritable bowel syndrome, levator ani syndrome, migraine and tension headaches, refractory severe subjective tinnitus, temporomandibular joint syndrome, urinary incontinence, and neuromuscular rehabilitation of stroke and traumatic brain injury. Biofeedback is considered not medically necessary when used to improve emotional and physical health in non-diseased persons. EEG biofeedback is considered experimental, investigational, or unproven for migraine and tension headache, and several listed uses are experimental, including amygdala-related EEG neurofeedback for PTSD, HeartMath HRV biofeedback for headaches, InTandem for walking in chronic stroke, and surface EMG biofeedback for chronic ankle instability. Some Aetna plans exclude coverage of biofeedback.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
CA-125
CA-125 measurement may be considered medically necessary in patients with symptoms suggestive of ovarian cancer or with known ovarian cancer. It may also be considered medically necessary for individual patients with other gynecologic malignancies, such as endometrial cancer, in whom baseline CA-125 levels have been shown to be elevated. Measurement of CA-125 is considered investigational in asymptomatic patients as a screening technique for ovarian cancer.
Independence Blue Cross · Effective Dec 29, 2025Low impact
05.00.74l, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Independence Blue Cross reissued medical policy 05.00.74l on 10/28/2026 with no substantive changes to TENS device coverage criteria. The policy clarifies medically necessary criteria for chronic pain (other than lower back pain) and experimental/investigational criteria. A prior change effective 12/29/2025 removed a specific pain reduction threshold requirement (50% reduction) from continued coverage criteria. This is a reissue communicating the company's continuing position; verify current applicability for your practice's active plans.
Independence Blue Cross · Effective Oct 1, 2025Low impact
05.00.74k, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Independence Blue Cross updated TENS policy 05.00.74k to 05.00.74l, replacing the single ICD-10 code R10.2 (Pelvic and perineal pain) with four more specific codes (R10.21, R10.22, R10.23, R10.24) effective 10/01/2025. This is a routine ICD-10 CM coding update to align with current coding specificity requirements; coverage criteria and billing codes remain unchanged.
Aetna · Identified Sep 29, 2026Low impact
Bio-Surgery: Medicinal Leech Therapy and Medical Maggots (CPB 0556, reviewed 2026-09-01)
Aetna's bio-surgery policy (CPB 0556, reviewed September 1, 2026) sets when medicinal leech therapy and medical maggots (bagged larval therapy) are covered, mainly for specific chronic wounds, flap and replant salvage. It lists many other uses, including knee and thumb osteoarthritis, low back pain and burns, as experimental, and the source gives a review date but no effective date.
Aetna · Identified Aug 12, 2026Low impact
Bio-Surgery: Medicinal Leech Therapy and Medical Maggots (CPB 0556, reviewed 2025-12-02)
This is historical material: an older Aetna policy (source dated 2025-12-02) for medicinal leech therapy and medical maggots (CPB 0556) that PolicyChanges found recently, and it states no effective date. It lists leech therapy for venous congestion and flap or replant salvage, and maggot debridement for certain non-healing wounds, as medically necessary, and it names many other uses, including knee osteoarthritis, low back pain and hemorrhoids, as experimental.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code G89.3?

There are 24 tracked policy changes affecting code G89.3, including updates from Independence Blue Cross, 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 G89.3?

Payers that have issued tracked updates for code G89.3 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

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Create a free account at PolicyChanges.app and save a search filtered to code G89.3. 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 G89.3?

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.

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MA05.006l, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies

05.00.74l, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies

MA05.006k, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies

Motor Cortex Stimulation (CPB 0755, reviewed 2026-10-21)

Pulsed Radiofrequency (CPB 0735, reviewed 2026-10-21)

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

Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)

Denosumab (CPB 0804, reviewed 2026-08-21)

Ziconotide (Prialt) (CPB 0712, reviewed 2026-03-11)

Thalamotomy (CPB 0153, reviewed 2026-03-30)

Nerve Blocks (CPB 0863, reviewed 2026-07-23)

Motor Cortex Stimulation (CPB 0755, reviewed 2026-02-24)

Stereotactic Cingulotomy and Capsulotomy (CPB 0288, reviewed 2026-04-16)

Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-07-29)

Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)

Pulsed Radiofrequency (CPB 0735, reviewed 2025-10-29)

Chronic Pain Rehabilitation Programs (CPB 0237, reviewed 2026-04-23)

Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)

Biofeedback (CPB 0132, reviewed 2026-07-16)

CA-125

05.00.74l, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies

05.00.74k, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies

Bio-Surgery: Medicinal Leech Therapy and Medical Maggots (CPB 0556, reviewed 2026-09-01)

Bio-Surgery: Medicinal Leech Therapy and Medical Maggots (CPB 0556, reviewed 2025-12-02)

What insurance policy changes affect code G89.3?

Which payers have updated policy for code G89.3?

How do I get notified when code G89.3 policy changes?

Why do payers change policies for code G89.3?