What insurance policy changes affect code K30?

There are 11 tracked policy changes affecting code K30, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code K30?

Payers that have issued tracked updates for code K30 include: Aetna.

How do I get notified when code K30 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code K30. 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 K30?

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

K30 Insurance Policy Changes

ICD-10 K30 is officially defined as "Functional dyspepsia." code K30 is referenced in 11 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 K30 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 30, 2026Medium impact
In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-26)
Aetna Clinical Policy Bulletin 0783 addresses in vivo analysis of gastrointestinal and urothelial lesions. It considers confocal laser endomicroscopy, including Cellvizio probe-based confocal laser endomicroscopy, and in-vivo analysis of colorectal polyps experimental, investigational, or unproven for the indications listed, because the effectiveness of these approaches has not been established. The source lists CPT and ICD-10 codes as not covered for the indications in the policy and gives a last review date of 10/26/2026.
Aetna · Identified Oct 27, 2026Medium impact
Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy (CPB 0678, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0678, last reviewed 10/21/2026, sets coverage criteria for gastric pacing, gastric electrical stimulation, and per-oral endoscopic myotomy (POEM). Gastric pacing or electrical stimulation is medically necessary for nausea and vomiting from chronic gastroparesis when gastric emptying scintigraphy confirms the diagnosis and the member is refractory or intolerant to dietary modification and to 2 of 3 prokinetic classes and 2 of 3 anti-emetic classes for at least 1 year. POEM for achalasia, POEM for Zenker diverticulum, and G-POEM for severe gastroparesis that meets the stated criteria are also listed as medically necessary, while many other uses are listed as experimental, investigational or unproven.
Aetna · Identified Oct 16, 2026Medium impact
Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-10-14)
Aetna considers TENS units medically necessary durable medical equipment when used as an adjunct or alternative to drugs for acute post-operative pain in the first 30 days after surgery, or for certain chronic, intractable pain not adequately responsive to other methods. Peripherally implanted nerve stimulators are considered medically necessary for intractable neuropathic pain when all listed criteria are met. Percutaneous electrical nerve stimulation is considered medically necessary for chronic low back pain secondary to degenerative disc disease for up to a 30-day period within a multi-modality rehabilitation program, and for diabetic neuropathy or neuropathic pain that has not responded to listed medications. Many other electrical stimulation devices and indications are listed as experimental, investigational, or unproven.
Aetna · Identified Oct 4, 2026Medium impact
Median Arcuate Ligament Syndrome: Treatment (CPB 1092)
Aetna has issued a new medical policy (CPB 1092) establishing coverage criteria for Median Arcuate Ligament Syndrome (MALS) treatment. The policy covers surgical decompression, percutaneous/surgical revascularization, and celiac plexus nerve blocks when specific diagnostic and clinical criteria are met, but classifies gastric tonometry as experimental. Billing teams must verify all prerequisite imaging and psychiatric assessments are documented before submitting claims for these procedures.
Aetna · Identified Aug 19, 2026Medium impact
In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2025-12-11)
Aetna Clinical Policy Bulletin 0783 considers confocal laser endomicroscopy (including Cellvizio probe-based confocal laser endomicroscopy) experimental, investigational, or unproven for the indications it lists, because the effectiveness of these approaches has not been established. The listed indications include assessment of safe surgical margins during laryngectomy, confirmation of low-grade dysplasia and surveillance of Barrett's esophagus, diagnosis and histologic grading of bladder cancer, diagnosis and staging of lung cancer, diagnosis of prostate cancer, diagnosis of head and neck squamous cell carcinoma, differentiation of colorectal polyps during routine colonoscopy, and diagnosis of indeterminate biliary strictures and pancreatic lesions. The policy also lists elastic-scattering spectroscopy for colonic polyps, ERCP with optical endomicroscopy for biliary lesions, and in vivo analysis of colorectal polyps (including chromoendoscopy, endocytoscopy, narrow-band imaging, multi-band imaging and the Optical Biopsy System) as experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (CPB 0738, reviewed 2025-10-29)
Upper gastrointestinal endoscopy (EGD) and GI biopsy are considered medically necessary when the listed criteria are met. Covered high-risk screening includes persons with chronic GERD of 5 years or more who are at risk for Barrett's esophagus, symptomatic pernicious anemia, and cirrhosis with portal hypertension and no prior variceal hemorrhage, and the policy also lists covered diagnostic, therapeutic and sequential or periodic surveillance indications. Routine screening EGD, EGD before bariatric surgery in asymptomatic persons, repeat EGD after a prior normal EGD when symptoms remain unchanged, and EGD for symptoms considered functional in origin are listed as experimental, investigational, or unproven. This is the full policy text is labeled as reviewed 2025-10-29 and includes no change note, and its policy history shows an original effective date of 11/09/2007.
Aetna · Identified Aug 17, 2026Medium impact
Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)
Aetna considers FDA-cleared carbon isotope (13C or 14C) urea breath testing and stool antigen testing (HpSA) medically necessary for active Helicobacter pylori infection in selected persons, including adults with idiopathic thrombocytopenic purpura, persons before bariatric surgery, persons before starting proton pump inhibitor therapy for dyspepsia, and persons taking long term, low-dose aspirin or initiating chronic NSAID treatment. Nucleic acid amplification for clarithromycin resistance testing is medically necessary for selecting salvage regimens for treatment-experienced individuals with persistent H. pylori infection. H. pylori serology, the AmHPR panel, IL-1B and TNFA gene polymorphism testing, and urea breath or stool antigen testing for other indications such as stroke risk, dementia risk and screening of asymptomatic persons are considered experimental, investigational or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Gastrointestinal Function: Selected Tests (CPB 0396, reviewed 2026-07-09)
Aetna considers colonic motility studies (colonic manometry) medically necessary to guide decision-making for surgery in children with refractory colonic motility or defecatory disorders. Aetna considers radionuclide gastric emptying studies medically necessary for the evaluation of gastrointestinal motility disorders and gastroparesis. Aetna considers magnetic resonance enterography medically necessary to evaluate and monitor Crohn's disease and other small bowel disorders. The following are considered experimental, investigational, or unproven because their effectiveness or clinical utility has not been established: 3D high-resolution manometry for quantification of esophago-gastric junction contractility; body surface gastric mapping (Gastric Alimetry) for gastric motility and gastroduodenal disorders and all other indications; electrogastrography; the gastric emptying breath test for gastroparesis and all other indications; high resolution esophageal pressure topography (HREPT); the immunoglobulin G antibody blood test to identify food triggers associated with irritable bowel syndrome (Biomerica inFoods IBS); the Malabsorption Evaluation Panel (Mayo Clinic Laboratories) for evaluation of intestinal dysbiosis, irritable bowel syndrome, malabsorption or small intestinal overgrowth of bacteria, and all other indications; the PillSense System for detection of upper gastrointestinal bleeding; and the SmartPill wireless capsule for measuring gastric emptying parameters for gastric disorders, intestinal motility disorders, and all other indications, because of inadequate published evidence of its diagnostic performance and clinical utility over conventional means of measuring gastric emptying. The policy lists CPT 91117 as covered for its listed indications and CPT 91132 and 91133 (electrogastrography) as not covered for those indications.
Aetna · Identified Aug 17, 2026Medium impact
Median Arcuate Ligament Syndrome: Treatment (CPB 1092, reviewed 12-2026-01)
Aetna has issued a new clinical policy (CPB 1092) establishing medical necessity criteria for Median Arcuate Ligament Syndrome (MALS) treatment, including surgical decompression, revascularization procedures, and celiac plexus nerve blocks. The policy specifies strict diagnostic imaging requirements, psychiatric assessment mandates, and defines when percutaneous vs. surgical interventions are appropriate. Gastric tonometry is explicitly classified as experimental/not covered.
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 13, 2026Medium impact
Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-06-03)
Aetna considers TENS medically necessary durable medical equipment as an adjunct or alternative to drugs for acute post-operative pain in the first 30 days after surgery, or for certain chronic intractable pain not adequately responsive to other methods such as physical therapy and pharmacotherapy. Peripherally implanted nerve stimulators are considered medically necessary for intractable neuropathic pain when the member meets all listed criteria, including a successful percutaneous stimulation trial that resulted in at least a 50% reduction in pain for a minimum of 3 days. TENS for chronic low back pain, PENS for opioid withdrawal, and many other electrical stimulation devices and indications are considered experimental, investigational, or unproven.

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In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2026-10-26)

Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy (CPB 0678, reviewed 2026-10-21)

Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-10-14)

Median Arcuate Ligament Syndrome: Treatment (CPB 1092)

In Vivo Analysis of Gastro-Intestinal and Urothelial Lesions (CPB 0783, reviewed 2025-12-11)

Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (CPB 0738, reviewed 2025-10-29)

Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)

Gastrointestinal Function: Selected Tests (CPB 0396, reviewed 2026-07-09)

Median Arcuate Ligament Syndrome: Treatment (CPB 1092, reviewed 12-2026-01)

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

Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-06-03)

What insurance policy changes affect code K30?

Which payers have updated policy for code K30?

How do I get notified when code K30 policy changes?

Why do payers change policies for code K30?