What insurance policy changes affect code R19.7?

There are 3 tracked policy changes affecting code R19.7, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R19.7?

Payers that have issued tracked updates for code R19.7 include: Aetna.

How do I get notified when code R19.7 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R19.7. 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 R19.7?

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

R19.7 Insurance Policy Changes

ICD-10 R19.7 is officially defined as "Diarrhea, unspecified." code R19.7 is referenced in 3 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 R19.7 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 19, 2026Medium impact
Inflammatory Disease: Biomarker and Thiopurine Pharmacogenomic Testing (CPB 0249, reviewed 2026-04-27)
In inflammatory bowel disease (IBD) and rheumatoid arthritis, TPMT gene or phenotypic testing is medically necessary before starting 6-mercaptopurine or azathioprine, with only one TPMT assay per member per lifetime, and NUDT15 gene analysis is medically necessary before starting any thiopurine (azathioprine, mercaptopurine or thioguanine). For IBD, fecal calprotectin is medically necessary for managing Crohn's disease and ulcerative colitis and for distinguishing IBD from irritable bowel syndrome, fecal lactoferrin is medically necessary for distinguishing IBD from irritable bowel syndrome, and 6-thioguanine nucleotide and 6-methylmercaptopurine nucleotide measurements are medically necessary to monitor compliance in patients not responding to 6-mercaptopurine and azathioprine therapy and to assess suspected toxicity. Many other biomarkers, antibody panels and genetic tests, including NOD2/CARD15 genotyping, PredictSURE IBD, Monitr Crohn's Disease Test and procalcitonin measurement, are considered experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Celiac Disease Laboratory Testing (CPB 0561, reviewed 2026-08-03)
Serological testing for IgA anti-human tissue transglutaminase (TTG), IgG and IgA deamidated gliadin (DGP), and IgA anti-endomysial (EMA) antibodies is medically necessary as a preliminary diagnostic test for persons with symptoms suggestive of celiac disease, to monitor response to a gluten-free diet, to screen first-degree relatives of individuals with celiac disease, and to screen persons with type 1 diabetes. HLA-DQ2 and HLA-DQ8 genetic testing is medically necessary for listed situations, including seronegative persons with equivocal small bowel histology findings (Marsh I-II), evaluation of persons on a gluten-free diet in whom no serologic testing was performed before starting it, and persons with Down syndrome. Anti-gliadin antibody (AGA) and anti-reticulin antibody (ARA) testing, the Prometheus Celiac Plus Panel, and HLA genotyping for screening persons with type 1 diabetes are experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Double Balloon Enteroscopy (CPB 0737, reviewed 2025-11-13)
Aetna considers double balloon enteroscopy medically necessary for dilation of small bowel strictures in Crohn's disease, evaluating suspected small bowel malignancies, evaluating the colon after incomplete colonoscopy, suspected Meckel's diverticulum with an indefinite imaging work-up, obscure GI bleeding with objective evidence of recurrent bleeding, removing entrapped foreign bodies in the small bowel, removing large polyps greater than 10 mm in Peutz-Jeghers syndrome, GI bleeding when the small intestine is the source, and use with ERCP in individuals with surgically altered upper GI anatomy. Aetna considers double balloon enteroscopy experimental, investigational or unproven for other indications, including detection of small bowel neuroendocrine tumors, small bowel varices, treatment of intussusception, treatment of angioectasia (type 1 small bowel vascular lesions), and treatment of post-operative bile leakage after hepaticojejunostomy. Combined double balloon enteroscopy and endoscopic ultrasound for evaluation of Crohn's disease is also considered experimental, investigational or unproven.

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Inflammatory Disease: Biomarker and Thiopurine Pharmacogenomic Testing (CPB 0249, reviewed 2026-04-27)

Celiac Disease Laboratory Testing (CPB 0561, reviewed 2026-08-03)

Double Balloon Enteroscopy (CPB 0737, reviewed 2025-11-13)

What insurance policy changes affect code R19.7?

Which payers have updated policy for code R19.7?

How do I get notified when code R19.7 policy changes?

Why do payers change policies for code R19.7?