J38.01 Insurance Policy Changes

ICD-10 J38.01 is officially defined as "Paralysis of vocal cords and larynx, unilateral." code J38.01 is referenced in 7 tracked payer policy changes from Independence Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code J38.01 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, 2025Medium impact
MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross MA07.050n policy for EMG/NCS studies was reissued with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis code G35 was replaced with five new subcategory codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D), and three S74.21X nerve injury codes had narrative corrections (high level changed to thigh level). No changes to covered procedures, CPT codes, or medical necessity criteria occurred.
Independence Blue Cross · Effective Sep 22, 2025Medium impact
MA07.050m, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross Medicare Advantage policy MA07.050n (effective 09/22/2025) expands coverage for electrodiagnostic studies by removing two "Not Medically Necessary" restrictions: pattern-setting limited limb EMG for radiculopathies and portable hand-held/point-of-care nerve conduction devices. Additionally, psychophysical measurements are now designated as Not Medically Necessary, and Visual Evoked Potentials (VEP) and Brainstem Auditory Evoked Potentials (BAEP) have been added as medically necessary services.
Independence Blue Cross · Effective Sep 22, 2025Medium impact
07.03.09w, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross updated policy 07.03.09w to 07.03.09x, expanding coverage for electrodiagnostic studies by removing prior restrictions on pattern-setting limited limb EMG for radiculopathies and portable/automated nerve conduction devices. New psychophysical measurement testing was added as not medically necessary, and Visual and Brainstem Auditory Evoked Potentials were explicitly added as covered services. Applicable CPT/HCPCS codes have been updated to align with these changes.
Aetna · Identified Aug 18, 2026Medium impact
Vocal Cord Paralysis / Insufficiency Treatments (CPB 0253, reviewed 2026-04-15)
Aetna Clinical Policy Bulletin 0253 addresses treatments for vocal cord paralysis and insufficiency. Aetna considers medically necessary injections of bulking agents for members with unilateral vocal cord paralysis when the agent is cleared by the FDA for this indication, medialization thyroplasty (type 1 thyroplasty), medialization laryngoplasty with arytenoid adduction, steroid injection after microsurgical removal of vocal fold lesions, Radiesse, autologous fat, Cymetra or Restylane when unilateral paralysis is anticipated to be short-term, laryngeal electromyography, and interarytenoid augmentation with an injectable filler for posterior laryngeal clefts in infants after a 3-month trial of conservative management has failed. Botulinum toxin injection for vocal cord paralysis, Deflux for velopharyngeal insufficiency, basic fibroblast growth factor, Juvederm, laryngeal reinnervation, posterior cricoarytenoideus re-innervation and pacing, injections of bulking agents for indications other than those listed as medically necessary, and transcutaneous laryngeal ultrasound for evaluation of hyaluronic acid status after injection laryngoplasty are considered experimental, investigational or unproven.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross updated ICD-10 diagnosis codes for MA07.050n (EMG/NCS policy) effective 10/01/2025. Multiple sclerosis code G35 was replaced with more specific codes (G35.A, G35.B0-B2, G35.C0-C2, G35.D), and three S74.21 nerve injury codes were corrected from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, CPT codes, or medical necessity criteria. This is a routine annual code update with no billing workflow impact.
Independence Blue Cross · Effective Oct 1, 2025Low impact
07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross reissued Policy 07.03.09x for EMG/NCS studies with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis codes were expanded from a single code (G35) to five specific subcategories (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D), and three S74.21X nerve injury codes had narrative corrections from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, medical necessity criteria, or billing codes.
Independence Blue Cross · Effective Oct 1, 2025Low impact
07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross reissued policy 07.03.09x on EMG/NCS studies with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis codes were granularized (G35 replaced with G35.A, G35.B0-B2, G35.C0-C2, G35.D), and three S74.21 nerve injury codes were corrected from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, CPT codes, or medical necessity criteria.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code J38.01?

There are 7 tracked policy changes affecting code J38.01, including updates from Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code J38.01?

Payers that have issued tracked updates for code J38.01 include: Independence Blue Cross, Aetna.

How do I get notified when code J38.01 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code J38.01. 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 J38.01?

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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MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

MA07.050m, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

07.03.09w, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

Vocal Cord Paralysis / Insufficiency Treatments (CPB 0253, reviewed 2026-04-15)