R42 Insurance Policy Changes

ICD-10 R42 is officially defined as "Dizziness and giddiness." code R42 is referenced in 15 tracked payer policy changes from Blue Shield of California, Blue Cross Blue Shield of North Dakota, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code R42 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Shield of California · Effective Aug 1, 2026High impact
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry (2.02.08)
Blue Shield of California medical policy 2.02.08, Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry, has an effective date of August 1, 2026. Outpatient cardiac telemetry (mobile cardiac outpatient telemetry, MCOT) may be considered medically necessary as a diagnostic alternative to ambulatory event monitors for infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias, such as severe palpitations, dizziness, or clinically significant presyncope or syncope, when the criteria below are met. Under the prior policy statement this use was considered investigational. Outpatient cardiac telemetry for any other condition, disease or symptoms, and ambulatory event monitors for asymptomatic individuals with risk factors for arrhythmia, are considered investigational.
Blue Cross Blue Shield of North Dakota · Identified Oct 24, 2026High impact
Medical Policy Updates for Non-Migrated Members
Blue Cross Blue Shield of North Dakota's October 22, 2026 notice for non-migrated commercial and Medicaid Expansion members lists medical policies reviewed by its Internal Medical Policy Committee on Oct. 13, 2026. The revised policies include reformatted criteria and policies with coding changes, such as procedure codes and diagnosis codes added to or removed from policies, including physical therapy covered-diagnosis lists and Category III T codes. The notice also lists tabled policies (Tumor Markers, where further research is needed) and states that benefit determinations are made based on the medical policy in effect at the time of service.
Aetna · Identified Oct 1, 2026Medium impact
Endolymphatic Hydrops (Meniere's Disease) Tests (CPB 0571, reviewed 2026-09-01)
Aetna considers dehydration testing with glycerol, urea, or other osmotic diuretics medically necessary to verify suspected endolymphatic hydrops (Meniere's disease) only in members with atypical presentations of the disease, and considers it experimental, investigational, or unproven for other indications. Aetna considers the following experimental, investigational, or unproven: endolymphatic sac immunohistochemistry of aquaporin-2, V2R, NKCC2 and TRPV4; genetic testing of KCNE1, KCNE3, SIK1, SLC8A1 and SLC26A4 for this diagnosis; intravenous gadolinium inner ear MRI; multi-frequency tympanometry; testing for antibodies against inner ear antigens; vestibular evoked myogenic potential (VEMP) testing for diagnosis and for monitoring disease progression; and the video head impulse test. The policy lists CPT codes 81406, 92517, 92518, 92519, 92550, 92567 and 92584 and HCPCS code A9579 as not covered for the indications listed, and ICD-10 codes for Meniere's disease, related vertigo, labyrinthitis, gait abnormalities and dizziness are covered if selection criteria are met.
Aetna · Identified Aug 19, 2026Medium impact
Vestibular Autorotation Test (VAT) (CPB 0467, reviewed 2026-08-03)
Aetna considers the vestibular autorotation test (VAT) experimental, investigational, or unproven for diagnosing vestibular disorders, vestibular migraine, or any other indication. Its sensitivity, specificity, reproducibility, and clinical utility have not been demonstrated. There are no specific codes for VAT, and the related CPT vestibular function test codes are 92541 through 92548.
Aetna · Identified Aug 18, 2026Medium impact
Holter Monitors (CPB 0019, reviewed 2026-03-13)
Aetna considers Holter monitoring medically necessary for diagnostic evaluation of adult members with listed conditions, including palpitations, syncope or near syncope, unexplained dizziness, and possible or documented long QT syndrome, and for asymptomatic congenital complete atrioventricular block in pediatric patients. Holter monitoring is considered experimental, investigational, or unproven for all other indications because its effectiveness for those indications has not been established. CPT codes 93224, 93225, 93226 and 93227 are covered if the selection criteria are met.
Aetna · Identified Aug 17, 2026Medium impact
Hippotherapy (CPB 0151, reviewed 2026-03-20)
Aetna considers hippotherapy, also called equine therapy, experimental, investigational, or unproven for the listed indications and for all other indications, because its effectiveness has not been established. The listed indications include autism, attention deficit and/or hyperactivity disorder, cerebral palsy or other motor dysfunctions, chronic pain, dementia, developmental delays, Down's syndrome, epilepsy, idiopathic scoliosis, post-traumatic stress disorder, childhood obesity, and substance use disorder. HCPCS code S8940 (equestrian/hippotherapy, per session) and the listed ICD-10 codes are not covered for these indications.
Aetna · Identified Aug 15, 2026Medium impact
Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)
Aetna considers CT perfusion studies of the brain medically necessary for evaluating acute stroke (less than 24 hours), including hemorrhagic stroke, subdural hemorrhage and transient ischemic attacks, for following up cerebral ischemia or infarction, for planning therapy for cervical or intracranial arterial occlusive disease, for identifying cerebral hyperperfusion after revascularization, and for evaluating the vascular status of solid tumors when MRI is degraded by susceptibility artifact. Aetna considers MRI perfusion studies medically necessary for diagnosing and following mass lesions such as glioma, for assessing acute stroke penumbra, and for assessing the hemodynamic significance of cervical or intracranial vascular stenosis and the efficacy of revascularization. Aetna considers CT perfusion experimental, investigational or unproven for indications including confirmation of brain death, differentiation of lung cancer from benign lesions, evaluation of head trauma and evaluation of cerebral vasospasm, and considers MRI perfusion unproven for indications including evaluation of traumatic brain injury, evaluation of persistent pain and prognostication of obstructive sleep apnea.
Aetna · Identified Aug 15, 2026Medium impact
Cardiac Event Monitors (CPB 0073, reviewed 2026-04-07)
Aetna considers external intermittent cardiac event monitors, external ECG monitoring for greater than 48 hours by continuous rhythm recording (such as the Zio Patch), mobile cardiovascular telemetry, and implantable loop recorders medically necessary when the listed criteria are met. The criteria cover syncope, lightheadedness, presyncope, palpitations and dizziness, and suspected atrial fibrillation as a cause of cryptogenic stroke, in members with a non-diagnostic Holter monitor or 48 hour telemetry or with symptoms that occur less often than daily. Aetna considers these monitors experimental, investigational, or unproven for all other indications, and it lists several handheld and self-monitoring ECG devices, including Kardia Mobile, Kardia 12L, KardiaMobile 6L, BodyGuardian, iHEART and the ViSi Mobile Monitoring System, as experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Coblation (CPB 0475, reviewed 2026-07-02)
Aetna considers coblation tonsillectomy medically necessary for peri-tonsillar abscess, recurrent middle ear infection where tonsillar hypertrophy is believed to be an exacerbating factor, recurrent or chronic tonsillar infection, and tonsillar hypertrophy leading to respiratory symptoms or airway obstruction. Aetna considers many other coblation uses experimental, investigational or unproven because their effectiveness has not been established, including coblation adenoidectomy, coblation nasal septal swell body reduction, coblation with or without gastrocnemius release for plantar fasciitis, coblation devices such as the Topaz Microdebrider for insertional Achilles tendinopathy and lateral epicondylitis, and radiofrequency to the nasal valve (Vivaer Nasal Airway Remodeling) for nasal airway obstruction. The policy lists cervical coblation nucleoplasty, coblation non-thermal volumetric tissue reduction, and several other coblation procedures as CPT codes not covered for the indications listed in the policy.
Aetna · Identified Aug 14, 2026Medium impact
Endolymphatic Hydrops (Meniere's Disease) Tests (CPB 0571, reviewed 2025-12-02)
Aetna considers dehydration testing with glycerol, urea, or other osmotic diuretics medically necessary to verify suspected endolymphatic hydrops (Meniere's disease) only in members with atypical presentations, and considers it experimental, investigational, or unproven for other indications. The policy also lists as experimental, investigational, or unproven: endolymphatic sac immunohistochemistry, genetic testing of KCNE1, KCNE3, SIK1, SLC8A1, and SLC26A4 for diagnosis, intravenous gadolinium inner ear MRI, multi-frequency tympanometry, testing for antibodies against inner ear antigens, VEMP for diagnosis and for monitoring disease progression, and the video head impulse test.
Aetna · Identified Aug 14, 2026Medium impact
Chronic Vertigo (CPB 0238, reviewed 2026-04-23)
Aetna considers the Epley and Semont maneuvers medically necessary for benign paroxysmal positional vertigo only when a positive Hallpike test confirms the diagnosis and the member has had symptoms for at least 4 months, and considers them experimental for members with central nervous system disorders such as temporal lobe epilepsy, multiple sclerosis, cerebrovascular disease, or cerebellar lesions. Vestibular rehabilitation is medically necessary for chronic vertigo or persistent postural-perceptual dizziness when symptoms have lasted more than 6 months, a vestibular disorder is confirmed or ablative vestibular surgery was performed, and medical management has failed. Dynamic posturography, the Meniett device, the DizzyFix, the GyroStim machine, the Biodex BioSway, the BTrackS system, and posterior semicircular canal occlusion are listed as experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Electrocochleogram and Perilymphatic Pressure Measurement (CPB 0564, reviewed 2026-07-30)
Aetna covers electrocochleography (CPT 92584) when it is used to evaluate episodic dizziness (vertigo or imbalance) or tinnitus to rule out endolymphatic hydrops (Meniere's disease) and perilymphatic fistula, or when it is performed with auditory brainstem response testing for profound hearing loss, defined as a pure tone average of 90 dB HL or greater at 500, 1,000, 2,000 and 4,000 Hz. Electrocochleography is experimental, investigational or unproven for routine hearing screening, for improving pre-implantation counseling for cochlear implant recipients, for intra-operative evaluation of cochlear trauma during cochlear implantation, and for superior semicircular canal dehiscence repair and canal resurfacing. Measurement of perilymphatic pressure is experimental, investigational or unproven for managing Meniere's disease or idiopathic sudden sensorineural hearing loss.
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.
Independence Blue Cross · Identified Jun 19, 2026Low impact
06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
This is a routine annual reissue of Independence Administrators' genetic testing policy for congenital Long QT Syndrome with no substantive changes to coverage criteria or billing codes. The policy clarifies that it applies only to members whose groups have NOT enrolled in the UM vendor program; groups with UM vendor enrollment should refer to the eviCore Lab Management Program instead.
Independence Blue Cross · Identified Jun 19, 2026Low impact
06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
This is a reissue of policy 06.02.31g with no substantive changes to coverage criteria for genetic testing of congenital Long QT Syndrome. The only modification is clarification of the applicability disclaimer: the policy now explicitly excludes groups enrolled in the UM vendor program, replacing the previous reference to eviCore Lab Management Program. Billing teams should verify member eligibility and UM vendor enrollment status before processing genetic testing claims.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code R42?

There are 15 tracked policy changes affecting code R42, including updates from Blue Shield of California, Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R42?

Payers that have issued tracked updates for code R42 include: Blue Shield of California, Blue Cross Blue Shield of North Dakota, Aetna, Independence Blue Cross.

How do I get notified when code R42 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R42. 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 R42?

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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Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry (2.02.08)

Medical Policy Updates for Non-Migrated Members

Endolymphatic Hydrops (Meniere's Disease) Tests (CPB 0571, reviewed 2026-09-01)

Vestibular Autorotation Test (VAT) (CPB 0467, reviewed 2026-08-03)

Holter Monitors (CPB 0019, reviewed 2026-03-13)

Hippotherapy (CPB 0151, reviewed 2026-03-20)

Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)

Cardiac Event Monitors (CPB 0073, reviewed 2026-04-07)

Coblation (CPB 0475, reviewed 2026-07-02)

Endolymphatic Hydrops (Meniere's Disease) Tests (CPB 0571, reviewed 2025-12-02)

Chronic Vertigo (CPB 0238, reviewed 2026-04-23)

Electrocochleogram and Perilymphatic Pressure Measurement (CPB 0564, reviewed 2026-07-30)

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

06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)

06.02.31g, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)

What insurance policy changes affect code R42?

Which payers have updated policy for code R42?

How do I get notified when code R42 policy changes?

Why do payers change policies for code R42?