Q61.2 Insurance Policy Changes

ICD-10 Q61.2 is officially defined as "Polycystic kidney, adult type." code Q61.2 is referenced in 4 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Q61.2 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 18, 2026Medium impact
Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)
Aetna considers hospitalization for initiation of a ketogenic diet medically necessary for intractable seizures, including Doose syndrome and Lennox-Gastaut syndrome, when all listed selection criteria are met, and for persons with glucose transporter protein type 1 deficiency or pyruvate dehydrogenase complex deficiency. Aetna considers hospitalization for initiation of a ketogenic diet of unproven value for all other indications, including adult super-refractory status epilepticus, Alzheimer's disease, autism spectrum disorder, cancer, migraine prevention, multiple sclerosis, Parkinson's disease, schizophrenia and type 2 diabetes. Hospitalization for initiation of the Atkins diet for intractable seizures, mitochondrial diseases, or other indications is considered experimental, investigational, or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Genetic Counseling (CPB 0189, reviewed 2026-03-27)
Aetna considers genetic counseling medically necessary for listed pregnancy-related indications, including couples who are closely related genetically, familial cancer disorders, pregnant women with maternal age 35 years or greater at delivery, and parents of a child born with a genetic disorder or birth defect. Genetic counseling unrelated to pregnancy is covered when it is appropriate for, or provided with, medically necessary genetic testing in accordance with ACMG guidelines. Genetic counseling for all other indications is considered experimental, investigational or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Automated Ambulatory Blood Pressure Monitoring (CPB 0025, reviewed 2026-03-12)
Aetna considers automated ambulatory blood pressure monitoring medically necessary when a member meets one of the listed criteria: at least two elevated office readings taken on separate days to identify 'white coat' hypertension; episodic hypertension with symptoms suggesting an adrenal tumor and repeatedly normal office readings; hypotensive symptoms or syncope thought related to antihypertensive medications; syncope evaluated with a 24-hour Holter monitor; nocturnal angina; resistant hypertension before an invasive investigation for secondary causes; or autosomal dominant polycystic kidney disease in children and young adults 30 years of age or younger. Monitoring for less than 24 hours or more than 3 days is not considered medically necessary, and repeat testing is not generally necessary more often than every 6 months. Aetna considers the use experimental, investigational, or unproven for heart failure, for pregnant women who do not meet the criteria, for diagnosing malignant hypertension, for members with an irregular cardiac rhythm such as atrial fibrillation, for routine monitoring to establish a hypertension diagnosis or evaluate treatment response, and for routine use before continuous positive airway pressure (CPAP) therapy.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Jynarque (tolvaptan)
Jynarque (tolvaptan) requires prior authorization. Under the initial criteria, the individual must be 18 years of age or older and have autosomal dominant polycystic kidney disease (ADPKD), must not have stage 5 chronic kidney disease (CKD), must not be on dialysis, must not use the requested agent with another tolvaptan agent, and the prescriber must be a specialist or have consulted with one. The policy history records a 05/26/2026 Pharmacy & Therapeutics revision that removed the documented diagnosis and clinical improvement requirement from the initial and renewal criteria.

Watch Q61.2

Get one email when a payer policy names Q61.2, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Q61.2?

There are 4 tracked policy changes affecting code Q61.2, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Q61.2?

Payers that have issued tracked updates for code Q61.2 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code Q61.2 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Q61.2. 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 Q61.2?

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

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)

Genetic Counseling (CPB 0189, reviewed 2026-03-27)

Automated Ambulatory Blood Pressure Monitoring (CPB 0025, reviewed 2026-03-12)

Jynarque (tolvaptan)

What insurance policy changes affect code Q61.2?

Which payers have updated policy for code Q61.2?

How do I get notified when code Q61.2 policy changes?

Why do payers change policies for code Q61.2?