R06.02 Insurance Policy Changes

ICD-10 R06.02 is officially defined as "Shortness of breath." code R06.02 is referenced in 11 tracked payer policy changes from Independence Blue Cross, Aetna, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code R06.02 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross MA07.050n policy for EMG/NCS studies was reissued with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis code G35 was replaced with five new subcategory codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D), and three S74.21X nerve injury codes had narrative corrections (high level changed to thigh level). No changes to covered procedures, CPT codes, or medical necessity criteria occurred.
Independence Blue Cross · Effective Sep 22, 2025Medium impact
MA07.050m, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross Medicare Advantage policy MA07.050n (effective 09/22/2025) expands coverage for electrodiagnostic studies by removing two "Not Medically Necessary" restrictions: pattern-setting limited limb EMG for radiculopathies and portable hand-held/point-of-care nerve conduction devices. Additionally, psychophysical measurements are now designated as Not Medically Necessary, and Visual Evoked Potentials (VEP) and Brainstem Auditory Evoked Potentials (BAEP) have been added as medically necessary services.
Independence Blue Cross · Effective Sep 22, 2025Medium impact
07.03.09w, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross updated policy 07.03.09w to 07.03.09x, expanding coverage for electrodiagnostic studies by removing prior restrictions on pattern-setting limited limb EMG for radiculopathies and portable/automated nerve conduction devices. New psychophysical measurement testing was added as not medically necessary, and Visual and Brainstem Auditory Evoked Potentials were explicitly added as covered services. Applicable CPT/HCPCS codes have been updated to align with these changes.
Aetna · Identified Nov 3, 2026Medium impact
Computerized Wheeze Detectors (CPB 0813, reviewed 2026-10-28)
Aetna's Clinical Policy Bulletin 0813 (reviewed 2026-10-28) classifies computerized wheeze detectors—including the PulmoTrack, Personal Wheezometer, and VRIxp devices—as experimental, investigational, or unproven for diagnostic evaluation of lung sounds, cough, and all other indications due to insufficient evidence of effectiveness. Claims for these devices will be denied for Aetna members.
Aetna · Identified Aug 18, 2026Medium impact
Influenza Rapid Diagnostic Tests (CPB 0476, reviewed 2026-07-24)
Aetna considers the following influenza diagnostic tests medically necessary when results will inform clinical management, antiviral treatment decisions, or infection control measures. These include rapid molecular assays (nucleic acid amplification tests), multiplex molecular assays that detect influenza A, influenza B, SARS-CoV-2, and/or respiratory syncytial virus, standard RT-PCR and other nucleic acid amplification tests, antigen-based rapid influenza diagnostic tests where molecular testing is not immediately available, and direct and indirect immunofluorescence assays when other testing modalities are not available. Confirmatory molecular testing following a negative rapid influenza diagnostic test is medically necessary during periods of high community influenza activity.
Aetna · Identified Aug 15, 2026Medium impact
Cardiopulmonary Exercise Testing (CPB 0825, reviewed 2025-12-03)
Aetna considers cardiopulmonary exercise testing (CPET, CPT 94621) medically necessary for listed conditions after standard testing, including echocardiography, pulmonary function testing with diffusion capacity, and oxygen desaturation measured on the 6-minute walk test. The listed conditions include post-operative evaluation of chronic thromboembolic pulmonary hypertension after pulmonary thromboendarterectomy, developing exercise prescriptions for cardiac or pulmonary rehabilitation, evaluating exercise capacity and response to therapy in chronic heart failure patients considered for heart transplantation or other advanced therapies, and evaluating post-acute sequelae of COVID-19 (Long COVID). CPET is considered experimental, investigational or unproven as a screening exercise test, as a routine pre-operative assessment, and as a first-line diagnostic test for possible cardiac or pulmonary pathology.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200475 - 02/2022)
The February 2022 Health First Colorado provider bulletin (B2200475) covers several changes. Effective February 1, 2022, claims requiring electronic visit verification (EVV) go through pre-payment review, and claims without the needed EVV records may deny with EOB 3054. The bulletin also describes at-home OTC COVID-19 test billing under HCPCS E1399 with modifier U1 from January 15, 2022, requires the ordering provider's NPI on DMEPOS claims effective July 1, 2022, and notes that 24 physician-administered drug codes became subject to prior authorization effective January 18, 2022.
Blue Cross Blue Shield of Wyoming · Identified Jun 19, 2026Medium impact
NEW! Screening for COVID-19 Diagnosis Guidance
BCBS Wyoming has updated COVID-19 diagnostic testing coding guidance with new ICD-10 codes and clarified coverage rules. The policy specifies that asymptomatic and pre-surgical COVID-19 testing is covered when medically appropriate, but not for return-to-work or surveillance purposes.
Independence Blue Cross · Effective Oct 1, 2025Low impact
MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross updated ICD-10 diagnosis codes for MA07.050n (EMG/NCS policy) effective 10/01/2025. Multiple sclerosis code G35 was replaced with more specific codes (G35.A, G35.B0-B2, G35.C0-C2, G35.D), and three S74.21 nerve injury codes were corrected from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, CPT codes, or medical necessity criteria. This is a routine annual code update with no billing workflow impact.
Independence Blue Cross · Effective Oct 1, 2025Low impact
07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross reissued Policy 07.03.09x for EMG/NCS studies with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis codes were expanded from a single code (G35) to five specific subcategories (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D), and three S74.21X nerve injury codes had narrative corrections from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, medical necessity criteria, or billing codes.
Independence Blue Cross · Effective Oct 1, 2025Low impact
07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Independence Blue Cross reissued policy 07.03.09x on EMG/NCS studies with ICD-10 code updates effective 10/01/2025. Multiple sclerosis diagnosis codes were granularized (G35 replaced with G35.A, G35.B0-B2, G35.C0-C2, G35.D), and three S74.21 nerve injury codes were corrected from 'hip and high level' to 'hip and thigh level'. No changes to covered procedures, CPT codes, or medical necessity criteria.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code R06.02?

There are 11 tracked policy changes affecting code R06.02, including updates from Independence Blue Cross, Aetna, Colorado Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R06.02?

Payers that have issued tracked updates for code R06.02 include: Independence Blue Cross, Aetna, Colorado Medicaid, Blue Cross Blue Shield of Wyoming.

How do I get notified when code R06.02 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R06.02. 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 R06.02?

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

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MA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

MA07.050m, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

07.03.09w, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies

Computerized Wheeze Detectors (CPB 0813, reviewed 2026-10-28)

Influenza Rapid Diagnostic Tests (CPB 0476, reviewed 2026-07-24)

Cardiopulmonary Exercise Testing (CPB 0825, reviewed 2025-12-03)

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200475 - 02/2022)

NEW! Screening for COVID-19 Diagnosis Guidance