I49.9 Insurance Policy Changes

ICD-10 I49.9 is officially defined as "Cardiac arrhythmia, unspecified." code I49.9 is referenced in 19 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I49.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Jun 15, 2026High impact
Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices - (Effective Date - 2026-06-15) 7.01.58
Excellus policy 7.01.58 Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices has a current effective date of June 15, 2026. Its 02/19/26 annual review moved cardiac contractility modulation (CCM) devices to policy 7.01.06, added new indications for upgrade to a CRT-D, added a medically appropriate statement for upgrading a single-chamber ventricular pacemaker (VVI) to a dual-chamber pacemaker (DDD), and added recurrent Adams-Stokes syndrome to the pacemaker indications for recurrent syncope. The update also deleted codes 0408T, 0409T, 0915T, 0916T and 0923T.
Excellus BlueCross BlueShield · Effective Jun 15, 2026High impact
Implantable Cardioverter Defibrillator (ICD) - (Effective Date - 2026-06-15) 7.01.06
Excellus policy 7.01.06 Implantable Cardioverter Defibrillator (ICD) has a current effective date of June 15, 2026. The 02/19/26 off-cycle update changed criteria for post cardiac arrest, structural heart disease with sustained VT, syncope of undetermined origin with a positive EP study, and unexplained syncope with sustained VT and normal LV function, and it added separate primary prevention and secondary prevention sections. The policy considers ICDs not medically necessary for incessant VT or VF, for VT or VF due to a reversible cause, and for ablation candidates with no structural heart disease.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Wearable Cardioverter Defibrillators
Prior authorization and Care Management approval are required for a wearable cardioverter defibrillator (WCD) used for ischemic cardiomyopathy following an acute myocardial infarction and for newly diagnosed nonischemic cardiomyopathy. Effective 2026-10-01, the Code Reference adds ICD-10 codes I42.00, I42.01, I42.09, I42.81, I42.89, I47.22, I49.81, I49.82, and I49.89 and removes ICD-9 diagnosis codes. A WCD is medically necessary as interim treatment for individuals who meet the ICD criteria but have a temporary contraindication to an ICD, such as a systemic infection, and as a bridge to left ventricular improvement or possible ICD implantation in the covered indications.
Excellus BlueCross BlueShield · Effective Jul 16, 2026Medium impact
Cardiac Event Monitors 2.01.03
External intermittent cardiac event monitors are medically appropriate for symptoms possibly related to rhythm disturbances (such as palpitations, or serious or significant syncope and near syncope), after an ablation, and after starting or stopping anti-arrhythmic drug therapy, when the specific criteria are met. Implantable loop recorders may be considered medically appropriate for specified indications, such as infrequent recurrent syncope, near syncope, or palpitations, paroxysmal atrial fibrillation, cryptogenic stroke, and post cardiac ablation, when the criteria are met, and home-based mobile cardiac outpatient telemetry is considered not medically necessary. External monitoring to measure heart rate variability or to detect ST segment changes, and intracardiac ischemia event monitors, are investigational.
Excellus BlueCross BlueShield · Effective May 21, 2026Medium impact
Genetic Testing for Cardiac Ion Channelopathies 2.02.38
Excellus BlueCross BlueShield medical policy 2.02.38, Genetic Testing for Cardiac Ion Channelopathies, has a current effective date of May 21, 2026, and its annual review on that date left the policy intent unchanged. Genetic testing for congenital long QT syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT) and Brugada syndrome is medically appropriate when signs or symptoms are present but a definitive diagnosis cannot be made without it, or for at-risk individuals who have a qualifying first-, second- or third-degree relative, in each case only when the test results will influence treatment decisions. Genetic testing to determine future risk of short QT syndrome (SQTS) is medically appropriate for asymptomatic individuals who have a first-, second- or third-degree relative with a known SQTS variant.
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 Oct 7, 2026Medium impact
Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)
Aetna considers measurement of plasma brain natriuretic peptide (BNP) medically necessary to differentiate dyspnea due to heart failure from pulmonary disease, to determine prognosis or severity in chronic heart failure, to screen for heart failure annually in adults with diabetes mellitus, to measure upon hospital admission and before discharge in acutely decompensated heart failure, for preoperative cardiac risk assessment before elevated-risk noncardiac surgery in members with known cardiovascular disease, age 65 or older, or age 45 or older with cardiovascular symptoms, and as an adjunct test for risk stratification of Stage C aortic stenosis. Serial BNP and NT-proBNP measurements and the other uses listed in the policy, such as diagnosing Kawasaki disease, are considered experimental, investigational, or unproven. CPT 83880 is covered when the selection criteria are met, except as a cardiovascular biomarker in healthy normal subjects and for identifying stress-induced myocardial ischemia.
Aetna · Identified Oct 5, 2026Medium impact
Ventricular Assist Devices (CPB 0654, reviewed 2026-09-10)
Aetna Clinical Policy Bulletin 0654 covers ventricular assist devices (VADs) and sets the criteria under which Aetna considers them medically necessary. A VAD is medically necessary as a bridge to transplant when the device has FDA approval for that indication and the member is awaiting heart transplantation. A VAD for destination therapy requires NYHA Class IV end-stage ventricular heart failure, a member who is not a candidate for heart transplant, an LVEF less than 25%, and the medical management and peak oxygen consumption criteria listed in the policy. Percutaneous VADs such as the TandemHeart and Impella are medically necessary for short-term circulatory support in cardiogenic shock and for listed high-risk PCI situations, and VADs are considered experimental, investigational, or unproven for all other indications.
Aetna · Identified Oct 2, 2026Medium impact
Cardiac Catheter Ablation (CPB 0165, reviewed 2026-08-25)
Aetna considers cardiac catheter ablation with electrophysiological studies medically necessary for listed atrial fibrillation, atrioventricular nodal reentrant tachycardia, atrial tachycardia and flutter, accessory pathway, and ventricular arrhythmia indications, each with its own clinical conditions such as symptoms, drug failure or intolerance, or a high-risk accessory pathway. Pulsed field ablation is considered an equally acceptable alternative to standard radiofrequency ablation for medically necessary indications. Ablation for all other indications is considered experimental, investigational, or unproven, and so are alcohol ablation of the vein of Marshall, the AtriCure Isolator Synergy EnCompass Clamp, cardio-neuro-ablation, intra-myocardial infusion-needle catheter ablation for ventricular tachycardia, non-invasive cardiac radio-ablation, and sinus node-sparing hybrid ablation.
Aetna · Identified Aug 18, 2026Medium impact
Ventricular Assist Devices (CPB 0654, reviewed 2026-07-17)
Aetna considers an FDA-approved ventricular assist device medically necessary as a bridge to transplant when the device has FDA approval for that indication, and as destination therapy when all of the listed criteria are met: NYHA Class IV end-stage heart failure, not a candidate for heart transplant, failure to respond to optimal medical management for at least 45 of the last 60 days (or balloon pump dependence for 7 days, or IV inotrope dependence for 14 days), LVEF less than 25%, and peak oxygen consumption less than or equal to 14 mL/kg/min. Percutaneous VADs such as the TandemHeart and the Impella are medically necessary for short-term circulatory support in cardiogenic shock and as an adjunct to high-risk PCI in the listed scenarios, and short-term LVADs, RVADs or BiVADs such as the CentriMag are medically necessary for up to 30 days in post-cardiotomy or refractory acute cardiogenic shock when the member is willing and able to be treated with heparin or an appropriate alternative anticoagulant. VADs are considered experimental, investigational or unproven for all other indications, including concomitant mitral valve surgery with LVAD implantation for mitral regurgitation, pVADs during ablation of ventricular tachycardia, implantable aortic counterpulsation ventricular assist systems, and use of mesenchymal precursor cells as adjunctive therapy in VAD recipients.
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 17, 2026Medium impact
Leadless Cardiac Pacemaker (CPB 0893, reviewed 2025-12-22)
Aetna considers FDA-approved leadless cardiac pacemakers, such as the Micra and Aveir systems, medically necessary when the member has symptomatic paroxysmal or permanent high-grade atrioventricular block, symptomatic bradycardia-tachycardia syndrome, or sinus node dysfunction (sinus bradycardia or sinus pauses), and also has a significant contraindication that precludes placement of conventional single chamber ventricular pacemaker leads. The listed contraindications are a history of an endovascular or cardiovascular implantable electronic device (CIED) infection or high risk for infection, limited access for trans-venous pacing, and the presence of a bio-prosthetic tricuspid valve. Aetna considers leadless pacemakers experimental, investigational, or unproven for all other indications, and considers a leadless pacemaker combined with cardiac resynchronization therapy, or with a subcutaneous implantable cardioverter-defibrillator for prevention of sudden cardiac death, 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 15, 2026Medium impact
Renal Sympathetic Nerve Ablation (CPB 0847, reviewed 2025-12-18)
Aetna considers microwave, radiofrequency, or ultrasound ablation of the renal sympathetic nerve experimental, investigational, or unproven for hypertension, heart failure, acute myocardial infarction, cardiac arrhythmias, ventricular tachycardia, obstructive sleep apnea, chronic kidney-related pain and chronic renal failure; the list is not all-inclusive. Transurethral renal pelvic denervation using radiofrequency ablation and cryoablation of the renal sympathetic nerve are experimental, investigational, or unproven for hypertension and all other indications. The CPT codes 0338T, 0339T and 0935T and the ICD-10 codes listed in the policy are not covered for the indications listed in the policy.
Aetna · Identified Aug 15, 2026Medium impact
Radiation Treatment for Selected Nononcologic Indications (CPB 0551, reviewed 2026-07-30)
Aetna considers low-dose or high-dose superficial or interstitial radiation medically necessary as adjunctive therapy immediately following excisional surgery, within 7 days, for keloids when keloid removal criteria are met. Radiation therapy is considered medically necessary to prevent heterotopic ossification in persons identified as being at high risk, and for Ledderhose disease when conventional treatments such as tamoxifen, verapamil and steroid injections have failed. Beta irradiation is considered medically necessary to prevent primary or recurrent pterygium in cases that cannot be managed medically, and radiation for osteoarthritis is considered medically necessary when specified criteria are met, while the TRASER device for nasal telangiectasias and ablative radiotherapy for cardiac arrhythmia are considered experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Event Monitors (CPB 0073, reviewed 2026-04-07)
Aetna considers external intermittent cardiac event monitors, external ECG monitoring for greater than 48 hours by continuous rhythm recording (such as the Zio Patch), mobile cardiovascular telemetry, and implantable loop recorders medically necessary when the listed criteria are met. The criteria cover syncope, lightheadedness, presyncope, palpitations and dizziness, and suspected atrial fibrillation as a cause of cryptogenic stroke, in members with a non-diagnostic Holter monitor or 48 hour telemetry or with symptoms that occur less often than daily. Aetna considers these monitors experimental, investigational, or unproven for all other indications, and it lists several handheld and self-monitoring ECG devices, including Kardia Mobile, Kardia 12L, KardiaMobile 6L, BodyGuardian, iHEART and the ViSi Mobile Monitoring System, as experimental, investigational, or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Catheter Ablation (CPB 0165)
Aetna considers catheter ablation with electrophysiological studies medically necessary for atrial fibrillation, AVNRT, atrial tachycardia and atrial flutter, accessory pathways, and ventricular arrhythmias when the listed criteria are met, such as symptomatic AF when antiarrhythmic drugs have been ineffective, contraindicated, not tolerated or not preferred. Aetna considers catheter ablation for all other indications experimental, investigational or unproven. The policy also lists alcohol ablation of the vein of Marshall, the AtriCure Isolator Synergy EnCompass Clamp, cardio-neuro-ablation for carotid sinus hypersensitivity syncope, intra-myocardial infusion-needle catheter ablation for ventricular tachycardia, non-invasive cardiac radio-ablation, and sinus node-sparing hybrid ablation as experimental, investigational or unproven. Pulsed field ablation is considered an equally acceptable alternative to standard radiofrequency ablation for medically necessary indications.
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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I49.9?

There are 19 tracked policy changes affecting code I49.9, including updates from Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code I49.9?

Payers that have issued tracked updates for code I49.9 include: Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code I49.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I49.9. 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 I49.9?

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.

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Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices - (Effective Date - 2026-06-15) 7.01.58

Implantable Cardioverter Defibrillator (ICD) - (Effective Date - 2026-06-15) 7.01.06

Wearable Cardioverter Defibrillators

Cardiac Event Monitors 2.01.03

Genetic Testing for Cardiac Ion Channelopathies 2.02.38

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

Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)

Ventricular Assist Devices (CPB 0654, reviewed 2026-09-10)

Cardiac Catheter Ablation (CPB 0165, reviewed 2026-08-25)

Ventricular Assist Devices (CPB 0654, reviewed 2026-07-17)

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

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

Leadless Cardiac Pacemaker (CPB 0893, reviewed 2025-12-22)

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

Renal Sympathetic Nerve Ablation (CPB 0847, reviewed 2025-12-18)

Radiation Treatment for Selected Nononcologic Indications (CPB 0551, reviewed 2026-07-30)

Cardiac Event Monitors (CPB 0073, reviewed 2026-04-07)

Cardiac Catheter Ablation (CPB 0165)

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

What insurance policy changes affect code I49.9?

Which payers have updated policy for code I49.9?

How do I get notified when code I49.9 policy changes?

Why do payers change policies for code I49.9?