ICD-10 K52.0 is officially defined as "Gastroenteritis and colitis due to radiation." code K52.0 is referenced in 6 tracked payer policy changes from Health Net, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code K52.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Health Net updated 16 medical policies with new prior authorization requirements, billing code changes, and coverage criteria changes for Q2 2021. Key changes include new CPT codes for ADHD testing that are now not medically necessary, updated HCPCS codes for skin substitutes, and revised criteria for multiple procedures including gender affirming care and spinal cord stimulation.
Health Net updated multiple medical policies for Q2 2021, including new policies for TMS treatment, EMG/nerve studies, and nasal valve repair, plus significant updates to ADHD testing codes, gender affirming procedures, and pain management nerve blocks. Multiple CPT, HCPCS, and ICD-10 codes were added, removed, or modified across various specialties.
CalViva Health (Medi-Cal) updated multiple medical policies for Q2 2021, affecting prior authorization requirements, billing codes, and coverage criteria across numerous specialties. Key changes include updated CPT codes for ADHD testing, nerve studies, and spinal procedures, plus revised criteria for gender-affirming procedures, pain management, and wound care.
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.
As last reviewed on May 21, 2026, Aetna considers multidisciplinary intestinal rehabilitation programs medically necessary for persons with parenteral nutrition-dependent intestinal failure. These programs usually include a team of dietitians, nurses, gastroenterologists, neonatologists and pediatric surgeons, and focus on diet and nutrition, medications, surgery and rehabilitation. Aetna considers intestinal rehabilitation programs experimental, investigational or unproven for all other indications.
Systemic hyperbaric oxygen pressurization may be considered medically necessary for non-healing diabetic wounds of the lower extremities that meet all three criteria, acute traumatic ischemia, decompression sickness, acute gas embolism, acute cyanide poisoning, acute carbon monoxide poisoning, soft-tissue radiation necrosis and osteoradionecrosis, pre- and post-treatment for dental surgery (non-implant related) of an irradiated jaw, gas gangrene, profound anemia with exceptional blood loss when transfusion is impossible or must be delayed, and chronic refractory osteomyelitis. Topical hyperbaric oxygen therapy is considered investigational. Systemic hyperbaric oxygen pressurization is considered investigational in all other situations, including compromised skin grafts or flaps, acute osteomyelitis, acute thermal burns, acute surgical and traumatic wounds, and chronic wounds other than diabetic wounds that meet the stated criteria.
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