I22.9 Insurance Policy Changes

ICD-10 I22.9 is officially defined as "Subsequent ST elevation (STEMI) myocardial infarction of unspecified site." code I22.9 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 I22.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 29, 2026Medium impact
Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2026-10-28)
Aetna's Clinical Policy Bulletin 0801 states that intra-coronary hyperoxemic therapy, also called aqueous oxygen therapy, is experimental, investigational or unproven for carbon monoxide poisoning, cardiogenic shock, radio-contrast nephropathy, reperfusion microvascular ischemia in persons with acute myocardial infarction, and stroke, because the evidence is insufficient. The policy lists ICD-10 codes as not covered for the indications listed in the policy, and says there are no specific CPT or HCPCS codes for hyperoxemic therapy.
Aetna · Identified Oct 5, 2026Medium impact
Thrombectomy Systems (CPB 0568, reviewed 2026-09-18)
Aetna considers the AngioJet Rheolytic Thrombectomy System medically necessary for removing fresh blood clots from arterio-venous fistulas used for hemodialysis, from coronary arteries or coronary bypass grafts that are at least 2.0 mm in diameter before angioplasty or stent placement, and from infra-inguinal peripheral arteries at least 2.0 mm in diameter. It also considers the system medically necessary for individuals with lower extremity deep vein thrombosis who have failed pharmacologic thrombolysis or in whom pharmacologic thrombolysis is contraindicated. Aetna considers the AngioJet system experimental, investigational or unproven for acute aortic occlusion, acute renal artery thrombosis, cerebral venous sinus thrombosis, inferior vena cava filter-related thrombosis, May-Thurner syndrome-related deep venous thrombosis, pulmonary embolism, and thrombosis of the native aortic valve and of the left ventricular assist device in individuals with heart failure. Aetna also considers the ClotHunter system for lower extremity deep vein thrombosis, and mechanical thrombectomy and/or thrombo-aspiration for acute ilio-femoral deep vein thrombosis, experimental, investigational or unproven.
Aetna · Identified Sep 29, 2026Medium impact
Adoptive Immunotherapy and Cellular Therapy (CPB 0641, reviewed 2026-09-25)
Aetna considers adoptive immunotherapy using tumor-infiltrating lymphocytes (TILs) or interleukin-2 activated lymphokine-activated killer (LAK) cells experimental, investigational or unproven for a long list of indications, including Alzheimer disease, esophageal, gynecologic, head and neck, hepatocellular, lung, glioblastoma, renal cell, pancreatic and other malignancies, because there is not adequate evidence that it is more beneficial than IL-2 alone. Melanoma is excluded from that list for lifileucel (Amtagvi), an FDA-approved TIL therapy. Cellular therapy (including embryonic cell, fresh cell, glandular, live cell, MAGE-A4 cell, organotherapy and xenotransplant therapy) is considered experimental, investigational or unproven for a long list of indications due to lack of adequate evidence, including angina, arthritis, diabetes, heart failure, hypertension, ischemic heart disease, ischemic stroke, motor neuron diseases, osteoarthritis and focal cartilage defects of the knee, peripheral arterial disease, and traumatic brain injury. Cancer is excluded from that list for afamitresgene autoleucel (Tecelra), an FDA-approved MAGE-A4-directed TCR T-cell therapy for synovial sarcoma. The policy also lists CAR T-cell therapy for solid tumors and virus-specific T-cell lymphocyte therapy for viral infections as experimental, investigational or unproven. HCPCS code S2107 (adoptive immunotherapy per course of treatment) and M0075 (cellular therapy) are listed as not covered for the indications in the policy.
Aetna · Identified Aug 18, 2026Medium impact
Thrombectomy Systems (CPB 0568, reviewed 2025-08-26)
Aetna considers the AngioJet Rheolytic Thrombectomy System medically necessary for removing fresh blood clots from arteriovenous fistulas used for hemodialysis, from coronary arteries or coronary bypass grafts at least 2.0 mm in diameter before angioplasty or stent placement, from infra-inguinal peripheral arteries at least 2.0 mm in diameter, and in individuals with lower extremity deep vein thrombosis who have failed pharmacologic thrombolysis or in whom pharmacologic thrombolysis is contraindicated. Thrombectomy systems are considered experimental, investigational or unproven for acute aortic occlusion, acute renal artery thrombosis, cerebral venous sinus thrombosis, inferior vena cava filter-related thrombosis, May-Thurner syndrome-related deep venous thrombosis, pulmonary embolism, and thrombosis of the native aortic valve and of the left ventricular assist device in heart failure. The ClotHunter for lower extremity deep vein thrombosis and mechanical thrombectomy or thrombo-aspiration for acute ilio-femoral deep vein thrombosis are also considered experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Intravascular Optical Coherence Tomography (CPB 0829, reviewed 2026-04-27)
Aetna considers intravascular optical coherence tomography (OCT) medically necessary for procedural guidance to reduce ischemic events in members with acute coronary syndrome (ACS) undergoing coronary stent implantation in the left main artery or in complex lesions. Aetna considers intravascular OCT experimental, investigational, or unproven for all other indications, including carotid artery stenosis/stroke risk, intracranial aneurysm diagnosis and rupture assessment, pulmonary artery thrombus, cardiac allograft vasculopathy, follow-up evaluation of post-stent placement, guidance of percutaneous treatment of coronary bifurcation disease, and follow-up evaluation of renal arteries after radiofrequency catheter-based renal denervation. This policy was last reviewed 04/27/2026.
Aetna · Identified Aug 18, 2026Medium impact
Holter Monitors (CPB 0019, reviewed 2026-03-13)
Aetna considers Holter monitoring medically necessary for diagnostic evaluation of adult members with listed conditions, including palpitations, syncope or near syncope, unexplained dizziness, and possible or documented long QT syndrome, and for asymptomatic congenital complete atrioventricular block in pediatric patients. Holter monitoring is considered experimental, investigational, or unproven for all other indications because its effectiveness for those indications has not been established. CPT codes 93224, 93225, 93226 and 93227 are covered if the selection criteria are met.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (CPB 0610, reviewed 2025-12-02)
Aetna considers FDA-approved biventricular pacemakers (cardiac resynchronization therapy) medically necessary for members with congestive heart failure who are in sinus rhythm when either NYHA class III or IV with LVEF less than or equal to 35%, QRS duration greater than or equal to 150 msec, and an optimal pharmacologic regimen of 3 months of maximally titrated doses as tolerated before implantation are met, or at least 40 days post myocardial infarction; or when NYHA class II to IV with LVEF less than or equal to 35%, left bundle branch block with QRS duration greater than or equal to 130 msec, and the same regimen or at least 40 days post MI are met. Aetna considers combination resynchronization-defibrillator devices medically necessary for members at high risk for sudden cardiac death when those criteria are met and at least one of the following applies: at least 1 episode of cardiac arrest from ventricular tachyarrhythmias, recurring poorly tolerated sustained ventricular tachycardia, a prior heart attack with documented non-sustained ventricular tachycardia and an inducible ventricular tachyarrhythmia, or a prior heart attack with LVEF less than or equal to 30%. Aetna considers left bundle branch pacing medically necessary when cardiac resynchronization therapy is indicated and left ventricular pacing cannot be accomplished, and considers biventricular pacing for atrial fibrillation, mild heart failure (NYHA class I), and anti-bradycardia pacing, wireless left ventricular endocardial pacing, His bundle pacing for cardiac resynchronization therapy, the galectin-3 test, and implantable diaphragmatic stimulation (VisCardia's VisONE system) experimental, investigational, or unproven.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I22.9?

There are 7 tracked policy changes affecting code I22.9, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I22.9?

Payers that have issued tracked updates for code I22.9 include: Aetna.

How do I get notified when code I22.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I22.9. 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 I22.9?

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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Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2026-10-28)

Thrombectomy Systems (CPB 0568, reviewed 2026-09-18)

Adoptive Immunotherapy and Cellular Therapy (CPB 0641, reviewed 2026-09-25)

Thrombectomy Systems (CPB 0568, reviewed 2025-08-26)

Intravascular Optical Coherence Tomography (CPB 0829, reviewed 2026-04-27)

Holter Monitors (CPB 0019, reviewed 2026-03-13)

Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (CPB 0610, reviewed 2025-12-02)

What insurance policy changes affect code I22.9?

Which payers have updated policy for code I22.9?

How do I get notified when code I22.9 policy changes?

Why do payers change policies for code I22.9?