I42.2 Insurance Policy Changes

ICD-10 I42.2 is officially defined as "Other hypertrophic cardiomyopathy." code I42.2 is referenced in 9 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 I42.2 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 Oct 1, 2026High impact
05.00.77g, Implantable Cardioverter Defibrillators
Independence Blue Cross updated ICD-10 diagnosis codes effective 10/01/2026 for Policy 05.00.77g (Implantable Cardioverter Defibrillators). Three codes were terminated (I42.0, I42.8, I49.8) and nine new codes were added with greater specificity, including new codes for Brugada syndrome (I49.81), catecholaminergic polymorphic ventricular tachycardia (I47.22), ventricular bigeminy (I49.82), and arrhythmogenic cardiomyopathy (I42.81). The policy itself was not fully reviewed; this is a routine annual ICD-10 code update.
Independence Blue Cross · Effective Apr 1, 2026Medium impact
05.00.77f, Implantable Cardioverter Defibrillators
Independence Blue Cross updated Medical Policy 05.00.77f to version 05.00.77g, expanding coverage to address transvenous, subcutaneous, and extravascular implantable cardioverter defibrillators (ICDs). The policy reissued on 04/01/2026 communicates the Company's continuing position on ICD coverage. Transvenous and subcutaneous ICDs remain covered when medical necessity criteria are met; extravascular ICDs remain experimental/investigational and not covered.
Independence Blue Cross · Effective Apr 1, 2026Medium impact
05.00.77f, Implantable Cardioverter Defibrillators
Independence Blue Cross updated policy 05.00.77f to 05.00.77g, expanding coverage to include transvenous, subcutaneous, and extravascular implantable cardioverter defibrillators (ICDs). The policy clarifies medical necessity criteria for primary prevention across multiple cardiac conditions and explicitly excludes extravascular ICDs as experimental/investigational. Billing teams must ensure claims are coded correctly and that extravascular ICD claims are denied per policy.
Aetna · Identified Oct 5, 2026Medium impact
T-Wave Alternans (CPB 0579, reviewed 2026-09-02)
Aetna's Clinical Policy Bulletin 0579 covers microvolt T-wave alternans testing using the spectral analytic method (CPT 93025) for evaluating persons at risk of sudden cardiac death who meet criteria for implantable cardioverter-defibrillator placement. The policy considers MTWA experimental, investigational or unproven for other uses, including diagnosis of acute coronary syndrome, diagnosis of reversible myocardial ischemia in individuals without structural heart disease, guidance of anti-arrhythmic therapy, evaluation of the adequacy of medical therapy, and prediction of major adverse cardiac events in ischemic heart failure. CPT 93025 is not covered for the diagnosis and risk assessment of acute coronary syndrome and for guiding anti-arrhythmic therapy.
Aetna · Identified Sep 30, 2026Medium impact
Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-08-21)
Aetna considers alcohol septal ablation (PTSMA) medically necessary for adults 21 years of age and older with hypertrophic obstructive cardiomyopathy when all listed criteria are met, including a clinical diagnosis of hypertrophic cardiomyopathy by echocardiography or cardiovascular MRI, severe symptoms that interfere with activities of daily living despite optimal drug therapy, NYHA functional class III or IV, and a peak LVOT gradient of 50 mm Hg or more. Aetna also considers PTSMA medically necessary for carefully selected members aged 5 to 20 with HOCM who meet separate pediatric criteria, and considers PTSMA for all other indications, SESAME, and ultrasound-guided PTSMA experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
T-Wave Alternans (CPB 0579, reviewed 2025-09-08)
Aetna considers microvolt T-wave alternans (MTWA) diagnostic testing using the spectral analytic method medically necessary for evaluating persons at risk of sudden cardiac death who meet criteria for implantable cardioverter-defibrillator placement. MTWA testing is experimental, investigational, or unproven for other indications, including diagnosis and risk assessment of acute coronary syndrome, guidance of anti-arrhythmic therapy, and evaluation of the adequacy of medical therapy. CPT 93025 is covered if selection criteria are met, but it is not covered for the diagnosis and risk assessment of acute coronary syndrome or for guiding anti-arrhythmic therapy.
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 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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
Under this BCBS policy, genetic testing for predisposition to hypertrophic cardiomyopathy may be considered medically necessary for individuals who have a first-degree relative with established hypertrophic cardiomyopathy, when a known pathogenic gene variant is present in that affected relative. Testing is considered investigational for individuals whose first-degree relative with established hypertrophic cardiomyopathy tested negative for pathogenic variants, and for all other populations. The policy history records an 08/18/2026 review with the policy statements unchanged and the code reference updated to remove ICD-9 diagnosis codes.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I42.2?

There are 9 tracked policy changes affecting code I42.2, 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 I42.2?

Payers that have issued tracked updates for code I42.2 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code I42.2 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I42.2. 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 I42.2?

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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05.00.77g, Implantable Cardioverter Defibrillators

05.00.77f, Implantable Cardioverter Defibrillators

05.00.77f, Implantable Cardioverter Defibrillators

T-Wave Alternans (CPB 0579, reviewed 2026-09-02)

Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (CPB 0558, reviewed 2026-08-21)

T-Wave Alternans (CPB 0579, reviewed 2025-09-08)

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

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

Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy

What insurance policy changes affect code I42.2?

Which payers have updated policy for code I42.2?

How do I get notified when code I42.2 policy changes?

Why do payers change policies for code I42.2?