What insurance policy changes affect code N94.3?

There are 2 tracked policy changes affecting code N94.3, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code N94.3?

Payers that have issued tracked updates for code N94.3 include: Aetna.

How do I get notified when code N94.3 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code N94.3. 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 N94.3?

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

N94.3 Insurance Policy Changes

ICD-10 N94.3 is officially defined as "Premenstrual tension syndrome." code N94.3 is referenced in 2 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 N94.3 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

Aetna · Identified Aug 13, 2026Medium impact
Progestins (CPB 0510, reviewed 2026-07-13)
Aetna considers medroxyprogesterone acetate injection (Depo-Provera CI or generic 150 mg/mL) medically necessary for pregnancy prevention and for gender dysphoria when the listed criteria are met. It considers the etonogestrel subdermal implant (Nexplanon) medically necessary for pregnancy prevention and for primary or secondary dysmenorrhea associated with endometriosis in adolescents, and it considers progestin-releasing IUDs (Kyleena, Mirena, Skyla and Liletta) medically necessary for contraception or heavy menstrual bleeding. Progesterone intramuscular injection is medically necessary for amenorrhea or abnormal uterine bleeding due to hormonal imbalance without organic pathology, and the policy considers it experimental, investigational, or unproven for other indications, including pregnancy prevention, twin pregnancies, endometrial hyperplasia, premenstrual syndrome and stroke.
Aetna · Identified Aug 13, 2026Medium impact
Premenstrual Syndrome and Premenstrual Dysphoric Disorder (CPB 0512, reviewed 2026-08-05)
Aetna's Clinical Policy Bulletin 0512 considers gynecological consultation, a medical evaluation with complete medical history and physical examination, thyroid function tests, cognitive behavioral therapy and bilateral oophorectomy medically necessary for premenstrual syndrome and premenstrual dysphoric disorder, with oophorectomy reserved for severe symptoms when all medical therapy has failed or produced unacceptable side effects. Psychiatric or psychological consultation and testing are medically necessary when the member exhibits mental or nervous symptoms. The policy lists acupuncture, aromatherapy, light therapy, intravenous magnesium, intravenous vitamin B6 and vitamin E, reflexology, vestibular stimulation, endometrial ablation, and several laboratory and neuroimaging tests as experimental, investigational or unproven.

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Progestins (CPB 0510, reviewed 2026-07-13)

Premenstrual Syndrome and Premenstrual Dysphoric Disorder (CPB 0512, reviewed 2026-08-05)

What insurance policy changes affect code N94.3?

Which payers have updated policy for code N94.3?

How do I get notified when code N94.3 policy changes?

Why do payers change policies for code N94.3?