T81.40XA Insurance Policy Changes

ICD-10 T81.40XA is officially defined as "Infection following a procedure, unspecified, initial encounter." code T81.40XA is referenced in 4 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 T81.40XA is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 29, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)
Aetna considers transcatheter aortic valve implantation (TAVI) medically necessary when criteria are met. Those criteria cover severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and an ejection fraction greater than 20%, and valve-in-valve replacement of a degenerated bioprosthetic aortic valve in patients with a Society of Thoracic Surgeons operative risk score of 8% or greater or a judged 15% or greater risk of mortality from surgical replacement. Percutaneous repair of prosthetic paravalvular leak is also considered medically necessary under specific conditions, while BASILICA, combined TAVI and left atrial appendage occlusion, embolic protection devices, TAVI for ongoing sepsis or endocarditis, and several prognostic tests are listed as experimental, investigational or unproven.
Aetna · Identified Oct 21, 2026Medium impact
Ultrasound Therapy for Wound Healing (CPB 0746, reviewed 2026-10-16)
Aetna considers ultrasound therapy, including high-frequency ultrasound and non-contact low-frequency ultrasound devices, experimental, investigational, or unproven for wound healing and for reduction of chronic wound pain, because the effectiveness of this approach for these indications has not been established. CPT 97610, low-frequency non-contact non-thermal ultrasound per day, is listed as not covered for the indications in this policy. Examples of ultrasound therapy named in this policy include the FAST procedure, the MIST Therapy System, the Qoustic Wound Therapy System, and the Sonoca 180/185 Wound Care System.
Aetna · Identified Aug 18, 2026Medium impact
Ultrasound Therapy for Wound Healing (CPB 0746, reviewed 2025-11-26)
Aetna considers ultrasound therapy for wound healing and for reduction of chronic wound pain experimental, investigational, or unproven, because its effectiveness for these indications has not been established. This includes high-frequency ultrasound and non-contact low-frequency ultrasound devices, such as the MIST Therapy System, the Qoustic Wound Therapy System, and the Sonoca 180/185 Wound Care System. CPT 97610 is listed as not covered for the indications in this policy.
Aetna · Identified Aug 18, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)
Aetna Clinical Policy Bulletin 0826 covers transcatheter aortic valve implantation (TAVI). Aetna considers TAVI with an FDA-approved valve medically necessary for severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and with an ejection fraction greater than 20%, and for valve-in-valve replacement of a degenerated bioprosthetic aortic valve when the STS operative risk score is 8% or greater or the member is judged to be at 15% or greater risk of mortality for surgical aortic valve replacement. Percutaneous repair of prosthetic paravalvular leak is medically necessary when intractable hemolysis or NYHA class III or IV symptoms, high or prohibitive surgical risk, suitable anatomy and a comprehensive valve center are all met, and BASILICA, combined TAVI and left atrial appendage occlusion, pre-implantation balloon aortic valvuloplasty, embolic protection devices, and TAVI for sepsis, bicuspid aortic stenosis, native aortic valve regurgitation or porcelain aorta are listed as experimental, investigational or unproven.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code T81.40XA?

There are 4 tracked policy changes affecting code T81.40XA, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code T81.40XA?

Payers that have issued tracked updates for code T81.40XA include: Aetna.

How do I get notified when code T81.40XA policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T81.40XA. 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 T81.40XA?

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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Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)

Ultrasound Therapy for Wound Healing (CPB 0746, reviewed 2026-10-16)

Ultrasound Therapy for Wound Healing (CPB 0746, reviewed 2025-11-26)

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)

What insurance policy changes affect code T81.40XA?

Which payers have updated policy for code T81.40XA?

How do I get notified when code T81.40XA policy changes?

Why do payers change policies for code T81.40XA?