J30.1 Insurance Policy Changes

ICD-10 J30.1 is officially defined as "Allergic rhinitis due to pollen." code J30.1 is referenced in 7 tracked payer policy changes from Excellus BlueCross BlueShield and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code J30.1 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 Jul 16, 2026Medium impact
Allergy Testing 2.01.10
Percutaneous, combined percutaneous and intracutaneous, intracutaneous, patch, photo patch, photo, inhalation bronchial challenge, ingestion challenge, and gammaglobulin IgE tests are medically appropriate in the diagnosis of the allergic patient, with allergen-specific IgE medically appropriate only under specified circumstances. Allergen-specific IgG when the criteria are not met, the leukocyte histamine release test, ophthalmic and direct nasal mucous membrane tests, peanut allergen-specific ELISA testing, and cytotoxicity, provocative, and Rebuck skin window tests are investigational, and allergy testing for treatment programs such as tolerance induction programs is investigational. The July 16, 2026 update was an annual review with the policy intent unchanged.
Aetna · Identified Oct 10, 2026Medium impact
Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)
Aetna considers repository corticotropin injection (Acthar Gel only) medically necessary for infantile spasms in members less than 2 years of age, and considers all other indications experimental, investigational, unproven, or not medically necessary. Precertification of Acthar Gel or Purified Cortrophin Gel is required of all Aetna participating providers and members in applicable plan designs. Purified Cortrophin Gel is considered experimental, investigational, or unproven for infantile spasms because it is not FDA-approved, nor has a compendial use, for this indication, and use of Acthar Gel in combination with Purified Cortrophin Gel is considered experimental, investigational, or unproven.
Aetna · Identified Oct 4, 2026Medium impact
Intranasal Ablation (CPB 0592, reviewed 2026-09-18)
Aetna considers radiofrequency volumetric tissue reduction (RFVTR, Somnoplasty) medically necessary for chronic nasal obstruction due to mucosal hypertrophy of the inferior turbinates, and considers RFVTR of the turbinates for snoring not medically necessary. CPT 30801 and 30802 are covered if the selection criteria are met, and CPT 31242 and 31243 are not covered for the indications listed. Coblation non-thermal volumetric tissue reduction for turbinate hypertrophy, coblation-assisted turbinoplasty for allergic rhinitis, cryoablation for chronic nasal obstruction or chronic rhinitis, radiofrequency ablation for rhinitis medicamentosa, RFVTR of the turbinates for obstructive sleep apnea, the RhinAer procedure, temperature-controlled radiofrequency neurolysis for chronic rhinitis, and the NEUROMARK System for chronic rhinitis are considered experimental, investigational, or unproven because the effectiveness and safety of these approaches has not been established.
Aetna · Identified Aug 18, 2026Medium impact
Tezepelumab-ekko (Tezspire) (CPB 1003, reviewed 2026-08-06)
Aetna's clinical policy for tezepelumab-ekko (Tezspire) covers it for commercial medical plans when it is medically necessary for severe asthma in members 12 years of age or older, or for chronic rhinosinusitis with nasal polyps (CRSwNP) in members 12 years of age or older, under the listed criteria. Asthma criteria include uncontrolled asthma within the past 12 months and inadequate control despite high dose inhaled corticosteroid plus an additional controller, or prior use of a biologic for asthma within the past 12 months. CRSwNP criteria include bilateral nasal polyposis and chronic sinusitis symptoms despite intranasal corticosteroids, plus prior sinonasal surgery or ineffective systemic corticosteroids within the last 24 months. Members cannot use it concomitantly with any other biologic or targeted synthetic drug for the same indication, and Aetna considers all other indications experimental, investigational, or unproven, including allergic broncho-pulmonary aspergillosis and combined tezepelumab and allergen immunotherapy for allergic rhinitis.
Aetna · Identified Aug 16, 2026Medium impact
Intranasal Ablation (CPB 0592, reviewed 2025-09-10)
Aetna considers radiofrequency volumetric tissue reduction (RFVTR, Somnoplasty) medically necessary for chronic nasal obstruction due to mucosal hypertrophy of the inferior turbinates, and considers RFVTR of the turbinates for snoring not medically necessary. Aetna considers coblation turbinate reduction, coblation-assisted turbinoplasty for allergic rhinitis, cryoablation for chronic nasal obstruction or chronic rhinitis, radiofrequency ablation for rhinitis medicamentosa, RFVTR for obstructive sleep apnea, the RhinAer procedure, temperature-controlled radiofrequency neurolysis, and the NEUROMARK System experimental, investigational, or unproven for the uses listed in the policy. CPT 30801 and 30802 are covered when the selection criteria are met.
Aetna · Identified Aug 16, 2026Medium impact
Septoplasty and Rhinoplasty (CPB 0005, reviewed 2026-03-12)
Aetna Clinical Policy Bulletin 0005 treats septoplasty as medically necessary for specific criteria, including documented recurrent sinusitis from a deviated septum not relieved by medical and antibiotic therapy, recurrent epistaxis related to a septal deformity, continuous nasal airway obstruction not responding to 4 or more weeks of appropriate medical therapy, and septoplasty done with cleft palate repair. Rhinoplasty is medically necessary only in limited circumstances, such as a nasal deformity from congenital cleft lip and/or palate, removal of a nasal dermoid, or an individually reviewed case of vestibular stenosis, and the policy considers rhinoplasty cosmetic for all other indications. Extracorporeal septoplasty for revision of a deviated septum, nasal valve suspension, septal swell body ablation, balloon septoplasty, and absorbable nasal implants for nasal valve reconstruction are listed as experimental, investigational, or unproven. The policy was last reviewed 03/12/2026.
Aetna · Identified Aug 16, 2026Medium impact
Rhinometry and Rhinomanometry (CPB 0700, reviewed 2025-11-24)
Aetna considers rhinomanometry, acoustic rhinometry, and optical rhinometry experimental, investigational, or unproven because clinical studies have not demonstrated that these tests improve clinical outcomes and the effectiveness of these approaches has not been established. CPT 92512 (nasal function studies, such as rhinomanometry) is listed as not covered for the indications in the policy. ICD-10 codes for acute sinusitis, chronic sinusitis, vasomotor and allergic rhinitis, deviated nasal septum, and hypertrophy of nasal turbinates are also listed as not covered for the indications in the policy.

Watch J30.1

Get one email when a payer policy names J30.1, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code J30.1?

There are 7 tracked policy changes affecting code J30.1, including updates from Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code J30.1?

Payers that have issued tracked updates for code J30.1 include: Excellus BlueCross BlueShield, Aetna.

How do I get notified when code J30.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code J30.1. 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 J30.1?

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

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

Allergy Testing 2.01.10

Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)

Intranasal Ablation (CPB 0592, reviewed 2026-09-18)

Tezepelumab-ekko (Tezspire) (CPB 1003, reviewed 2026-08-06)

Intranasal Ablation (CPB 0592, reviewed 2025-09-10)

Septoplasty and Rhinoplasty (CPB 0005, reviewed 2026-03-12)

Rhinometry and Rhinomanometry (CPB 0700, reviewed 2025-11-24)

What insurance policy changes affect code J30.1?

Which payers have updated policy for code J30.1?

How do I get notified when code J30.1 policy changes?

Why do payers change policies for code J30.1?