I63.9 Insurance Policy Changes

ICD-10 I63.9 is officially defined as "Cerebral infarction, unspecified." code I63.9 is referenced in 16 tracked payer policy changes from Blue Shield of California, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I63.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Shield of California · Effective Aug 1, 2026High impact
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry (2.02.08)
Blue Shield of California medical policy 2.02.08, Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry, has an effective date of August 1, 2026. Outpatient cardiac telemetry (mobile cardiac outpatient telemetry, MCOT) may be considered medically necessary as a diagnostic alternative to ambulatory event monitors for infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias, such as severe palpitations, dizziness, or clinically significant presyncope or syncope, when the criteria below are met. Under the prior policy statement this use was considered investigational. Outpatient cardiac telemetry for any other condition, disease or symptoms, and ambulatory event monitors for asymptomatic individuals with risk factors for arrhythmia, are considered investigational.
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.
Blue Cross & Blue Shield of Mississippi · Effective Jan 1, 2026Medium impact
Computed Tomography Perfusion Imaging of the Brain
Computed tomography perfusion imaging of the brain may be considered medically necessary to select individuals with anterior large-vessel stroke for mechanical embolectomy, and it is considered investigational for all other indications. Effective 01/01/2026, the code reference added CPT 70472 (with concurrent CT or CT angiography of the same anatomy) and CPT 70473 (without concurrent CT or CT angiography of the same anatomy). CPT 40042T was deleted 12/31/2025.
Aetna · Identified Oct 23, 2026Medium impact
Actigraphy and Accelerometry (CPB 0710, reviewed 2026-10-15)
Aetna considers actigraphy testing (for example, Actiwatch) and accelerometry experimental, investigational, or unproven for listed uses, including diagnosing sleep disorders, diagnosing Alzheimer's disease, diagnosing hypertension, detecting seizures during sleep, and monitoring individuals with motor neuron diseases. CPT 95803 (actigraphy testing, minimum of 72 hours to 14 consecutive days of recording) and many listed ICD-10 codes, including those for depression, schizophrenia, Parkinson's disease and cerebral infarction, are not covered for the indications listed.
Aetna · Identified Oct 22, 2026Medium impact
Ziconotide (Prialt) (CPB 0712, reviewed 2026-10-14)
Aetna considers intrathecal ziconotide (Prialt) medically necessary for members with severe chronic pain that is intolerant of or refractory to other treatments, such as systemic analgesics, adjunctive therapies, or intrathecal morphine. Aetna considers it not medically necessary for members with a pre-existing history of psychosis, an infection at the micro-infusion injection site, uncontrolled bleeding diathesis, or spinal canal obstruction. Aetna considers intrathecal ziconotide experimental, investigational, or unproven for autism, epilepsy, Irukandji syndrome, migraines, primary lateral sclerosis, stroke and other indications, and considers the intrathecal combination of ziconotide, morphine and levobupivacaine experimental for cancer-related refractory pain.
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
Infrared Therapy (CPB 0604, reviewed 2026-09-09)
Aetna considers infrared coagulation medically necessary for anal dysplasia and for members with grade I, II, or III internal hemorrhoids that are painful or persistently bleeding. Low-level infrared light therapy is considered experimental, investigational, or unproven for a long list of indications, including osteoarthritis, migraines, stroke, and diabetes mellitus, and the infrared glove is unproven for Raynaud's syndrome and all other indications. CPT 46930 is covered when selection criteria are met, while CPT 97026 and HCPCS codes A4639 and E0221 are not covered for the listed indications.
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 17, 2026Medium impact
Afamelanotide (Scenesse) (CPB 0962, reviewed 2025-12-09)
Aetna considers afamelanotide (Scenesse) medically necessary for biochemically confirmed erythropoietic protoporphyria in adult members whose protoporphyrin level is above the lab reference range in peripheral red blood cells. Aetna considers continuation of afamelanotide therapy medically necessary for adult members with that indication who are experiencing benefit from therapy while receiving it. Aetna considers all other indications experimental, investigational, or unproven, including inhibition of drug-resistant pathogenic bacteria such as MRSA and treatment of acute ischemic stroke, and this policy applies to commercial medical plans.
Aetna · Identified Aug 17, 2026Medium impact
ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)
Aetna considers the ADAMTS13 assay medically necessary for assessing prognosis in persons with thrombotic thrombocytopenic purpura (TTP), and for distinguishing hematopoietic stem cell transplant-associated thrombotic microangiopathy (HSCT-TMA, also called transplant-associated TMA) from TTP in persons with overlapping features when the test will be used to inform treatment. Aetna considers the assay experimental, investigational, or unproven for the uses it lists because of insufficient evidence, including sepsis-associated thrombotic microangiopathy, hemolytic uremic syndrome, acute myelogenous leukemia, colorectal cancer survival, COVID-19, cerebral infarction, and ADAMTS13 mutation testing for non-cirrhotic portal hypertension.
Aetna · Identified Aug 15, 2026Medium impact
Fecal Bacteriotherapy (CPB 0844, reviewed 2026-03-25)
Aetna's commercial clinical policy bulletin 0844 covers fecal bacteriotherapy. It considers fecal microbiota transplant medically necessary for Clostridium difficile infection (CDI) confirmed by a positive C. difficile toxin stool test that has recurred after at least one course of adequate antibiotic therapy. It considers a single rectal dose of Rebyota (fecal microbiota, live-jslm) medically necessary for preventing CDI when the policy's criteria are met, and it considers other listed indications, including alcoholic hepatitis, Crohn's disease, ulcerative colitis and irritable bowel syndrome, 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 Devices and Procedures for Occlusion of the Left Atrial Appendage (CPB 0791, reviewed 2026-06-25)
Aetna's Clinical Policy Bulletin 0791 covers percutaneous left atrial appendage closure (LAAC) for non-valvular atrial fibrillation only when the device has FDA premarket approval for its FDA-approved indication, the member meets the listed criteria, and LAAC is used as second-line therapy after oral anticoagulants. Surgical left atrial appendage ligation is covered for members with atrial fibrillation and a CHADS2 or CHA2DS2-VASc score of at least 2 who are undergoing open heart surgery and will continue long-term anticoagulation after surgery. Exclusion of the appendage alone during open heart surgery, the AtriClip device, and percutaneous closure with any device other than the Amplatzer Amulet and Watchman are listed as experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Catheter-Directed Cardiac Procedures (CPB 0292, reviewed 2026-08-04)
Aetna considers transcatheter closure of atrial septal defects with FDA-approved devices medically necessary for closure of a fenestration after the Fontan procedure, for a secundum ASD with a Qp:Qs ratio of at least 1.5, right ventricular enlargement and pulmonary vascular resistance under 5 Wood units (or 5 to 8 Wood units that fall below 5 with PAH treatment), and for an ASD with strong suspicion of paradoxical embolism. Transcatheter PFO occlusion is medically necessary for adults aged 18 to 60 after a non-lacunar cryptogenic stroke with an atrial septal aneurysm or a large right-to-left shunt of at least 20 bubbles, and transcatheter VSD closure is medically necessary for complex VSDs in patients at high risk for standard surgical closure. Transcatheter PDA closure is medically necessary with the Amplatzer duct occluder or another FDA-approved device for that indication, while closure for migraine, heart failure interatrial shunts, the APTURE system, the Neovasc Reducer, the Nit-Occlud Le VSD coil and AngioVac debulking are considered experimental, investigational or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Acute Ischemic Stroke Treatments (CPB 0789, reviewed 2025-11-19)
Endovascular therapy with a retrievable stent is medically necessary for acute ischemic stroke with occlusion of the middle cerebral artery trunk or its branches, or the internal carotid artery, when salvageable tissue is shown on imaging and retrieval is performed within 12 hours after stroke onset. Intra-arterial infusion of spasmolytics such as papaverine, or calcium-channel blockers such as nicardipine, into intracranial arteries is medically necessary only for medically refractory symptomatic delayed cerebral ischemia (cerebral vasospasm) after aneurysmal subarachnoid hemorrhage, and is experimental, investigational, or unproven for all other indications. Acute stenting with concomitant tirofiban, cerebrolysin, defibrinogen therapy, erythropoietin, hypothermia, transcranial ultrasound such as the CLOTBUST-HF device, sphenopalatine ganglion stimulation, statins, and vagus nerve stimulation for myocardial atrophy after AIS are experimental, investigational, or unproven, along with several other listed therapies.
Aetna · Identified Aug 12, 2026Medium impact
Actigraphy and Accelerometry (CPB 0710, reviewed 2025-10-14)
Aetna considers actigraphy testing experimental, investigational, or unproven for indications including defining lithium response dimensions in bipolar disorders, detection or screening of apnea, diagnosis of Alzheimer's disease, diagnosis of hypertension, evaluation of depression, and evaluation of schizophrenia. Aetna considers accelerometry experimental, investigational, or unproven for indications including evaluating functional ability in the elderly, differential diagnosis of tremor syndromes, gait analysis in persons with hip osteoarthritis, and monitoring of physical activity during rehabilitation of persons with stroke. CPT code 95803 (actigraphy testing, recording, analysis, interpretation and report, minimum of 72 hours to 14 consecutive days of recording) and CPT codes 0533T through 0536T (continuous recording of movement disorder symptoms) are not covered for the indications listed in the policy.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I63.9?

There are 16 tracked policy changes affecting code I63.9, including updates from Blue Shield of California, Excellus BlueCross BlueShield, 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 I63.9?

Payers that have issued tracked updates for code I63.9 include: Blue Shield of California, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code I63.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I63.9. 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 I63.9?

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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Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry (2.02.08)

Cardiac Event Monitors 2.01.03

Computed Tomography Perfusion Imaging of the Brain

Actigraphy and Accelerometry (CPB 0710, reviewed 2026-10-15)

Ziconotide (Prialt) (CPB 0712, reviewed 2026-10-14)

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

Infrared Therapy (CPB 0604, reviewed 2026-09-09)

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

Afamelanotide (Scenesse) (CPB 0962, reviewed 2025-12-09)

ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)

Fecal Bacteriotherapy (CPB 0844, reviewed 2026-03-25)

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

Cardiac Devices and Procedures for Occlusion of the Left Atrial Appendage (CPB 0791, reviewed 2026-06-25)

Catheter-Directed Cardiac Procedures (CPB 0292, reviewed 2026-08-04)

Acute Ischemic Stroke Treatments (CPB 0789, reviewed 2025-11-19)

Actigraphy and Accelerometry (CPB 0710, reviewed 2025-10-14)

What insurance policy changes affect code I63.9?

Which payers have updated policy for code I63.9?

How do I get notified when code I63.9 policy changes?

Why do payers change policies for code I63.9?