What insurance policy changes affect code J40?

There are 7 tracked policy changes affecting code J40, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code J40?

Payers that have issued tracked updates for code J40 include: Aetna.

How do I get notified when code J40 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code J40. 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 J40?

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.

PAYER POLICY CHANGES

J40 Insurance Policy Changes

ICD-10 J40 is officially defined as "Bronchitis, not specified as acute or chronic." code J40 is referenced in 7 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code J40 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 4, 2026Medium impact
Home/Ambulatory Spirometry (CPB 0572, reviewed 2026-09-01)
Aetna's Clinical Policy Bulletin 0572 on home and ambulatory spirometry was last reviewed 09/01/2026. Aetna considers home spirometry and telespirometry medically necessary for lung transplant recipients, and experimental, investigational or unproven for asthma, cystic fibrosis, idiopathic pulmonary fibrosis, interstitial lung disease and other chronic pulmonary disorders such as emphysema. Spirometry Holter is also considered experimental, investigational or unproven for managing asthma, and CPT 94014, 94015 and 94016 and HCPCS E0487 are covered when selection criteria are met.
Aetna · Identified Oct 4, 2026Medium impact
Heart-Lung Transplantation (CPB 0597, reviewed 2026-09-08)
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Examples of qualifying conditions include COPD with severe heart failure, cystic fibrosis with severe heart failure, congenital heart disease with pulmonary hypertension that is not amenable to lung transplantation and repair by standard cardiac surgery, and Eisenmenger's complex with irreversible pulmonary hypertension and severe heart failure. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function.
Aetna · Identified Aug 18, 2026Medium impact
Home/Ambulatory Spirometry (CPB 0572, reviewed 2025-08-26)
Aetna considers home spirometry and telespirometry medically necessary for lung transplant recipients. It considers them experimental, investigational or unproven for asthma, cystic fibrosis, idiopathic pulmonary fibrosis, interstitial lung disease and other chronic pulmonary diseases such as emphysema. CPT 94014, 94015 and 94016 and HCPCS E0487 are covered only if the selection criteria are met.
Aetna · Identified Aug 17, 2026Medium impact
Heart-Lung Transplantation (CPB 0597, reviewed 2025-12-02)
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function, and every attempt should be made to preserve the heart. The member must meet the transplanting institution's selection criteria, and in the absence of those criteria, Aetna's listed criteria apply.
Aetna · Identified Aug 13, 2026Medium impact
Peak Flow Meters (CPB 0059, reviewed 2026-03-18)
Aetna considers standard mechanical peak flow meters and spacers for metered-dose inhalers medically necessary durable medical equipment for members with asthma, bronchitis, emphysema, or other obstructive pulmonary conditions. Aetna considers electronic peak flow meters, including the PeakLog and AirWatch systems, experimental, investigational, or unproven because their effectiveness has not been established compared with standard mechanical peak flow meters. Peak flow meters should not be used to diagnose chronic obstructive pulmonary disease.
Aetna · Identified Aug 13, 2026Medium impact
Palivizumab (Synagis) (CPB 0318, reviewed 2025-11-24)
Aetna considers palivizumab (Synagis) medically necessary for commercial medical plans for up to 5 doses per RSV season to prevent serious lower respiratory tract disease caused by RSV, when a member has a qualifying diagnosis such as prematurity, chronic lung disease of prematurity, hemodynamically significant congenital heart disease, cystic fibrosis or profound immunocompromise and the associated criteria are met. Palivizumab is excluded for members who have received nirsevimab-alip (Beyfortus) in the same RSV season. The American Academy of Pediatrics stated that in July 2025 it no longer routinely recommends using Synagis.

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

Home/Ambulatory Spirometry (CPB 0572, reviewed 2026-09-01)

Heart-Lung Transplantation (CPB 0597, reviewed 2026-09-08)

Home/Ambulatory Spirometry (CPB 0572, reviewed 2025-08-26)

Heart-Lung Transplantation (CPB 0597, reviewed 2025-12-02)

Peak Flow Meters (CPB 0059, reviewed 2026-03-18)

Palivizumab (Synagis) (CPB 0318, reviewed 2025-11-24)

What insurance policy changes affect code J40?

Which payers have updated policy for code J40?

How do I get notified when code J40 policy changes?

Why do payers change policies for code J40?