What insurance policy changes affect code R13.19?

There are 11 tracked policy changes affecting code R13.19, including updates from Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R13.19?

Payers that have issued tracked updates for code R13.19 include: Independence Blue Cross, Aetna.

How do I get notified when code R13.19 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R13.19. 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 R13.19?

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

R13.19 Insurance Policy Changes

ICD-10 R13.19 is officially defined as "Other dysphagia." code R13.19 is referenced in 11 tracked payer policy changes from Independence Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code R13.19 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 Oct 25, 2026Medium impact
Dysphagia Therapy (CPB 0625, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0625 on dysphagia therapy states which treatments it considers medically necessary and which it considers experimental, investigational, or unproven. Speech therapy for dysphagia, esophageal dilation for symptomatic obstruction of the esophagus, and non-biodegradable, non-drug eluting stent placement for refractory malignant esophageal strictures are medically necessary when the member meets the policy's criteria. Acupuncture, electrical stimulation, transcranial direct current stimulation, hyperbaric oxygen therapy for radiation-induced dysphagia and several other interventions are listed as experimental, investigational, or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Suction Pumps (CPB 0503, reviewed 2026-07-02)
Aetna considers home model respiratory suction pumps medically necessary as durable medical equipment for members who have difficulty raising and clearing secretions because of cancer or surgery of the throat or mouth, dysfunction of the swallowing muscles, a tracheostomy, or unconsciousness or an obtunded state. Gastric suction pumps are medically necessary for members who are unable to empty gastric secretions through normal gastrointestinal functions. Wound suction is considered medically necessary only when the quantity of exudate exceeds the capacity of conservative measures such as surgical dressings and wound fillers to contain it. Aetna considers subcutaneous peritoneal ascites pumps such as the alfa-pump System experimental, investigational, or unproven for managing ascites and for the other indications the policy lists.
Aetna · Identified Aug 15, 2026Medium impact
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)/Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) and Laryngopharyngeal Endoscopic Esthesiometer (LPEER) (CPB 0248, reviewed 2026-04-13)
Aetna considers both fiberoptic endoscopy and videofluoroscopy medically necessary for evaluating swallowing function, and considers FEES the preferred test over videofluoroscopy when one of the listed conditions applies, such as a need for a more conservative exam because of aspiration concerns, a need to assess swallowing status over a meal, a repeat exam to assess change, severe dysphagia, a need to visualize the larynx after intubation or surgery, or when positioning or transporting the member for fluoroscopy is problematic. Aetna considers the sensory testing component (endoscopic air pulse stimulation) of FEESST medically necessary for members with persistent dysphagia who meet the FEES criteria. Aetna considers modified barium swallow study medically necessary when it is performed by a speech-language pathologist and radiologist after dysphagia has been diagnosed and further follow-up is needed, and considers FEES for disorder of consciousness, LPEER for laryngopharyngeal mechano-sensitivity, and modified barium swallow study performed for screening experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Eagle's and Ernest Syndrome (CPB 0400, reviewed 2026-06-30)
Aetna's Clinical Policy Bulletin 0400 considers styloidectomy medically necessary for Eagle's syndrome only when specific criteria are met, with separate criteria for the non-vascular form and the vascular form linked to carotid artery dissection. Radiofrequency thermoneurolysis is considered experimental, investigational or unproven for Eagle's and Ernest syndromes, and styloidectomy for jugular vein stenosis, for carotid stenosis without dissection, and for other listed indications such as tinnitus, headache and neck pain is also considered experimental, investigational or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Pediatric Intensive Feeding Programs (CPB 0809, reviewed 2025-12-11)
Aetna considers professional services for pediatric intensive feeding programs medically necessary for infants and children with complex feeding and swallowing disorders when an interdisciplinary team provides the care and every listed condition is met. Those conditions include behavior problems interfering with feeding, a documented diagnosis-specific treatment plan with estimated length of treatment, medical causes of failure to thrive treated without resolving the feeding problem, physician coordination and oversight, one of the listed feeding problems, and no response to initial treatment by a single discipline over a 2-month period. Other indications, such as childhood obesity and Prader-Willi syndrome, are considered experimental, investigational, or unproven, and electrical stimulation for swallowing or feeding disorders is also considered experimental, investigational, or unproven.
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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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

Dysphagia Therapy (CPB 0625, reviewed 2026-10-21)

Suction Pumps (CPB 0503, reviewed 2026-07-02)

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)/Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) and Laryngopharyngeal Endoscopic Esthesiometer (LPEER) (CPB 0248, reviewed 2026-04-13)

Eagle's and Ernest Syndrome (CPB 0400, reviewed 2026-06-30)

Pediatric Intensive Feeding Programs (CPB 0809, reviewed 2025-12-11)