What insurance policy changes affect code G93.49?

There are 5 tracked policy changes affecting code G93.49, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code G93.49?

Payers that have issued tracked updates for code G93.49 include: Aetna.

How do I get notified when code G93.49 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code G93.49. 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 G93.49?

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.

PAYER POLICY CHANGES

G93.49 Insurance Policy Changes

ICD-10 G93.49 is officially defined as "Other encephalopathy." code G93.49 is referenced in 5 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code G93.49 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 3, 2026Medium impact
Rituximab (CPB 0314, reviewed 2026-09-15)
Aetna Clinical Policy Bulletin 0314 sets coverage criteria for rituximab (Rituxan), rituximab-abbs (Truxima), rituximab-arrx (Riabni), rituximab-pvvr (Ruxience) and rituximab and hyaluronidase human (Rituxan Hycela) under commercial medical plans. Precertification is required for these products in applicable plan designs. Rituximab is covered for the listed hematologic and oncologic conditions and for the listed rheumatoid arthritis and other conditions when the stated criteria are met, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Metreleptin (Myalept) (CPB 0882, reviewed 2026-07-10)
Aetna requires precertification for metreleptin (Myalept) for all participating providers and members in applicable plan designs. Aetna considers metreleptin medically necessary for congenital or acquired generalized lipodystrophy when the initial approval criteria are met, and considers it experimental, investigational, or unproven for partial lipodystrophy, HIV-related lipodystrophy, generalized obesity not associated with generalized lipodystrophy, and liver disease including metabolic dysfunction associated steatohepatitis (MASH). Continuation of therapy is medically necessary when the member has improved from baseline in metabolic control and continues dietary modifications along with regular exercise.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)
Aetna considers quantitative EEG (brain mapping, also called BEAM) medically necessary only as an adjunct to traditional EEG for specified uses, including ambulatory EEG recording to facilitate later expert visual interpretation, continuous EEG monitoring by frequency-trending in the operating room or ICU, and topographic voltage and dipole analysis in pre-surgical evaluations for intractable epilepsy. Aetna considers quantitative EEG experimental, investigational or unproven for all other indications, including attention disorders, autism spectrum disorders, depression, schizophrenia, bipolar disorder, insomnia, fibromyalgia, post-traumatic stress disorder and post-concussion syndrome. The BrainScope One System (Ahead 300) is considered experimental, investigational or unproven for evaluation of concussion or traumatic brain injury.
Aetna · Identified Aug 14, 2026Medium impact
Embolization: Selected Procedures (CPB 0856, reviewed 2026-01-12)
Aetna considers alcohol embolization or sclerotherapy and/or surgery for symptomatic venous malformations medically necessary when there is pain, swelling, ulceration, or hemorrhage. Coil embolization is medically necessary for arterio-venous malformations and aneurysms, congenital aorto-azygous fistula, splenic artery aneurysm and gastric varices, and embolization is medically necessary for lower gastro-intestinal bleeding, for renal angiomyolipoma with active bleeding or a size greater than 6 cm, and for several other listed indications. Aetna considers hemorrhoidal embolization, endovascular lymphatic ablation, Onyx embolization for the treatment of CSF vertebral vein fistula, coil embolization of the hypogastric veins for deep vein thrombosis, and several other listed procedures experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)
Magnetic resonance spectroscopy (MRS) is considered medically necessary for specific indications in this policy, including assessing prognosis in hypoxic ischemic encephalopathy, distinguishing low grade from high grade gliomas, and distinguishing recurrent brain tumor from radiation-induced tumor necrosis. MRS is considered experimental, investigational, or unproven for all other indications listed, including breast cancer, prostate cancer, epilepsy, dementia and movement disorders, and traumatic brain injury. CPT 76390 is covered for the listed indications, and CPT codes 0609T, 0610T, 0611T and 0612T are not covered for the indications listed. The policy was last reviewed 03/26/2026.

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Rituximab (CPB 0314, reviewed 2026-09-15)

Metreleptin (Myalept) (CPB 0882, reviewed 2026-07-10)

Quantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)

Embolization: Selected Procedures (CPB 0856, reviewed 2026-01-12)

Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)

What insurance policy changes affect code G93.49?

Which payers have updated policy for code G93.49?

How do I get notified when code G93.49 policy changes?

Why do payers change policies for code G93.49?