What insurance policy changes affect code I05.0?

There are 7 tracked policy changes affecting code I05.0, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I05.0?

Payers that have issued tracked updates for code I05.0 include: Aetna.

How do I get notified when code I05.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I05.0. 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 I05.0?

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

I05.0 Insurance Policy Changes

ICD-10 I05.0 is officially defined as "Rheumatic mitral stenosis." code I05.0 is referenced in 7 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 I05.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 11, 2026Medium impact
Signal-Averaged Electrocardiography (SAECG) and Artificial Intelligence Algorithmic Electrocardiogram (CPB 0664, reviewed 2026-10-07)
Aetna considers signal-averaged electrocardiography, AI-based technology for detection or screening of acute coronary syndrome and early detection of hypertension, assistive AI algorithmic electrocardiogram assessment for cardiac dysfunction and heart failure (including the MyoVista Wavelet ECG Cardiac Testing Device and ECG-AI LEF), remote algorithmic analysis of electrocardiographic-derived data (Premier Heart's Multifunction Cardiogram, also known as 3DMP Computerized EKG System), and vMap non-invasive arrhythmia analysis for planning and executing catheter ablation experimental, investigational or unproven. CPT codes 0764T, 0765T, 0897T and 93278 are listed as not covered for the indications named in the policy. ICD-10 codes I49.01 through I49.9 and I05.0 through I52 are also listed as not covered for those indications.
Aetna · Identified Sep 30, 2026Medium impact
Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-08-25)
Aetna considers transcatheter edge-to-edge repair with an FDA-approved device, such as the MitraClip NTR/XTR Clip Delivery System, medically necessary for chronic mitral regurgitation that remains symptomatic despite maximal doses of medical therapy in members with symptomatic severe primary mitral regurgitation who are not considered good candidates for mitral valve surgery, or with symptomatic severe secondary mitral regurgitation who have a left ventricular ejection fraction between 20% and 50%, a left ventricular end-systolic diameter of 70 mm or less, and a pulmonary artery systolic pressure of 70 mmHg or less. Transcatheter mitral valve-in-valve replacement with an FDA-approved device, such as the Edwards-Sapien 3 valve, is considered medically necessary for symptomatic failing surgical bioprosthetic mitral valves when a heart team including a cardiac surgeon judges the member to be at high or greater risk for open surgical therapy, meaning a predicted risk of surgical mortality of 8% or higher at 30 days. Transcatheter edge-to-edge repair with the TriClip device is considered medically necessary for severe tricuspid regurgitation with symptomatic heart failure when all listed criteria are met, while caval valve implantation, transcatheter tricuspid valve replacement, and trans-apical mitral valve repair are considered experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Signal-Averaged Electrocardiography (SAECG) and Artificial Intelligence Algorithmic Electrocardiogram (CPB 0664, reviewed 2025-12-08)
Aetna considers signal-averaged electrocardiography (SAECG), AI-based detection or screening for acute coronary syndrome, early detection of hypertension, assistive AI algorithmic electrocardiogram assessment for cardiac dysfunction and heart failure, remote algorithmic analysis such as the Multifunction Cardiogram (MCG), and vMap non-invasive arrhythmia analysis for planning and executing catheter ablation experimental, investigational or unproven. CPT codes 93278, 0764T, 0765T and 0897T are listed as not covered for the indications in the policy. ICD-10 codes I49.01 through I49.9 and I05.0 through I52 are listed as not covered for the indications in the policy.
Aetna · Identified Aug 14, 2026Medium impact
Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)
Balloon valvuloplasty is medically necessary for severe rheumatic mitral stenosis, severe aortic stenosis, and pulmonary valve stenosis when the listed criteria are met. For mitral stenosis with favorable valve anatomy, the criteria include a cumulative echocardiographic score of 8 or less. Balloon dilation for all other indications not listed is experimental, investigational, or unproven, including balloon aortic valvuloplasty used to select transcatheter heart valve size and percutaneous balloon valvuloplasty for bioprosthetic tricuspid valve stenosis.
Aetna · Identified Aug 14, 2026Medium impact
Intensive Cardiac Rehabilitation Programs (CPB 0267, reviewed 2026-05-14)
Aetna considers intensive cardiac rehabilitation programs (the Benson-Henry Institute Cardiac Wellness Program, the Ornish cardiac treatment program and the Pritikin Program) medically necessary as an alternative to traditional Phase II cardiac rehabilitation for members who meet the cardiac rehabilitation criteria, limited to 72 one-hour sessions, up to 6 per day, over a period of up to 18 weeks. Virtual delivery by real-time audio and video (excluding audio-only) is considered medically necessary when the telehealth program and member criteria are met, but hospital outpatient departments are not eligible for virtual telehealth services. Intensive cardiac rehabilitation is considered experimental, investigational or unproven for diabetes, hyperlipidemia, prostate cancer, metabolic syndrome and all other indications where effectiveness has not been established.
Aetna · Identified Aug 13, 2026Medium impact
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-02-19)
Aetna Clinical Policy Bulletin 0558 considers percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion medically necessary for hypertrophic obstructive cardiomyopathy (HOCM) in adults 21 years of age and older when all listed criteria are met, including severe symptoms despite optimal drug therapy, NYHA class III or IV, a peak LVOT gradient of at least 50 mm Hg, and suitable coronary anatomy with an identifiable septal perforator artery. Aetna also considers PTSMA medically necessary for carefully selected members 5 to 20 years of age with HOCM when the pediatric criteria are met, and it considers PTSMA for all other indications, SESAME, and ultrasound-guided PTSMA experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-06-05)
Aetna covers transcatheter mitral valve repair with an FDA-approved device such as the MitraClip for members with chronic mitral regurgitation who remain symptomatic despite maximal doses of medical therapy and meet the listed primary or secondary regurgitation criteria. Transcatheter tricuspid valve repair with the TriClip device is covered only for members with severe tricuspid regurgitation, symptomatic heart failure NYHA class II, III, or IVa, and the other listed criteria, and tricuspid valve repair that does not meet these criteria is considered experimental, investigational, or unproven. Mitral valve-in-valve replacement with the Edwards-Sapien 3 valve is covered for symptomatic failing surgical bioprosthetic mitral valves in members a heart team judges to be at high or greater risk for open surgery.

Watch I05.0

Get one email when a payer policy names I05.0, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Signal-Averaged Electrocardiography (SAECG) and Artificial Intelligence Algorithmic Electrocardiogram (CPB 0664, reviewed 2026-10-07)

Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-08-25)

Signal-Averaged Electrocardiography (SAECG) and Artificial Intelligence Algorithmic Electrocardiogram (CPB 0664, reviewed 2025-12-08)

Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)

Intensive Cardiac Rehabilitation Programs (CPB 0267, reviewed 2026-05-14)

Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-02-19)

Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-06-05)

What insurance policy changes affect code I05.0?

Which payers have updated policy for code I05.0?

How do I get notified when code I05.0 policy changes?

Why do payers change policies for code I05.0?