What insurance policy changes affect code R07.1?

There are 2 tracked policy changes affecting code R07.1, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R07.1?

Payers that have issued tracked updates for code R07.1 include: Aetna.

How do I get notified when code R07.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R07.1. 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 R07.1?

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

R07.1 Insurance Policy Changes

ICD-10 R07.1 is officially defined as "Chest pain on breathing." code R07.1 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 R07.1 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 Oct 17, 2026Medium impact
Esophageal and Airway pH Monitoring (CPB 0667, reviewed 2026-10-07)
Aetna Clinical Policy Bulletin 0667 on esophageal and airway pH monitoring, reviewed 2026-10-07, considers esophageal pH monitoring medically necessary for listed indications, such as refractory reflux in members with chest pain after cardiac evaluation, and for evaluating vomiting in infants up to 3 months of age. The policy considers multi-channel intraluminal impedance testing medically necessary for certain reflux and dysphagia indications, and considers airway pH monitoring, pharyngeal pH monitoring and airway impedance measurement experimental, investigational or unproven. This is an older source dated 2026-10-07, which is historical material, and it states no effective date.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve (CPB 0228, reviewed 2026-07-21)
Aetna considers cardiac CT and coronary CT angiography (CCTA) medically necessary when criteria are met, including CCTA on a 64-slice or greater scanner to rule out obstructive coronary stenosis in symptomatic persons with low or intermediate pre-test probability of coronary artery disease. Calcium scoring is covered for asymptomatic adults aged 40 to 75 with a borderline or intermediate (5% to 19.9%) 10-year risk of cardiac events who are not on a statin, have no history of diabetes, and have no family history of premature CAD. Aetna considers CCTA experimental, investigational or unproven for persons with a BMI greater than 40 (except when 3rd generation dual-source CT at 120 kV is used), for screening asymptomatic persons, and for persons with extensive coronary calcification or a prior Agatston score greater than 1000, and repeat calcium scoring is covered only when the most recent scan was zero, at least 5 years ago, and discovery of coronary calcium would change management.

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Esophageal and Airway pH Monitoring (CPB 0667, reviewed 2026-10-07)

Cardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve (CPB 0228, reviewed 2026-07-21)

What insurance policy changes affect code R07.1?

Which payers have updated policy for code R07.1?

How do I get notified when code R07.1 policy changes?

Why do payers change policies for code R07.1?