Z86.73 Insurance Policy Changes

ICD-10 Z86.73 is officially defined as "Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits." code Z86.73 is referenced in 5 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 Z86.73 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
Intermittent Pneumatic Compression Devices (CPB 0500, reviewed 2026-07-10)
Aetna considers full-leg or half-leg home-use pneumatic compression devices medically necessary durable medical equipment for chronic venous insufficiency of the legs in members with venous stasis ulcers that have failed to heal after a 6-month trial of conservative therapy directed by the treating physician. Intermittent pneumatic compression devices for the lower extremities are considered medically necessary for members who are bedridden due to trauma, orthopedic surgery, neurosurgery or other circumstances preventing ambulation, and a single patient use device is considered not medically necessary. Aetna lists other uses as experimental, investigational or unproven, including treatment of critical limb ischemia, intermittent claudication, post-thrombotic syndrome, restless legs syndrome and intra-operative compression for reduction of venous thromboembolism in craniotomy.
Aetna · Identified Aug 17, 2026Medium impact
Aducanumab-avwa (Aduhelm) (CPB 0996, reviewed 2025-12-09)
Aetna considers aducanumab-avwa (Aduhelm) medically necessary for treatment of Alzheimer's disease for commercial medical plans when the initial approval criteria are met, and considers all other indications experimental, investigational or unproven. Aduhelm requires precertification, and Aduhelm was discontinued in November 2024.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)
Aetna considers quantitative EEG (brain mapping, also called BEAM) medically necessary only as an adjunct to traditional EEG for specified uses, including ambulatory EEG recording to facilitate later expert visual interpretation, continuous EEG monitoring by frequency-trending in the operating room or ICU, and topographic voltage and dipole analysis in pre-surgical evaluations for intractable epilepsy. Aetna considers quantitative EEG experimental, investigational or unproven for all other indications, including attention disorders, autism spectrum disorders, depression, schizophrenia, bipolar disorder, insomnia, fibromyalgia, post-traumatic stress disorder and post-concussion syndrome. The BrainScope One System (Ahead 300) is considered experimental, investigational or unproven for evaluation of concussion or traumatic brain injury.
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 13, 2026Medium impact
Donanemab-azbt (Kisunla) (CPB 1066, reviewed 2025-10-17)
Aetna considers Kisunla (donanemab-azbt) medically necessary for Alzheimer's disease when the member is 50 or older, or is younger with an APP, PSEN1 or PSEN2 mutation or other documentation of early onset AD, is in Clinical Stage 3 or 4, has objective cognitive impairment, and has amyloid pathology confirmed by PET or by cerebrospinal fluid results. The initial criteria also require a brain MRI within one year before treatment, ApoE e4 genotype testing, a baseline CDR-GS of 0.5 or 1, MMSE of 21 to 30, or MoCA of 16 or greater within 12 months of treatment initiation, and participation in a provider-enrolled registry such as ALZ-NET. Anticoagulants may not be used with the drug, any antiplatelet agent must be used as monotherapy at a standard therapeutic dose, and precertification is required.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z86.73?

There are 5 tracked policy changes affecting code Z86.73, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z86.73?

Payers that have issued tracked updates for code Z86.73 include: Aetna.

How do I get notified when code Z86.73 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z86.73. 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 Z86.73?

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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Intermittent Pneumatic Compression Devices (CPB 0500, reviewed 2026-07-10)

Aducanumab-avwa (Aduhelm) (CPB 0996, reviewed 2025-12-09)

Quantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)

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

Donanemab-azbt (Kisunla) (CPB 1066, reviewed 2025-10-17)

What insurance policy changes affect code Z86.73?

Which payers have updated policy for code Z86.73?

How do I get notified when code Z86.73 policy changes?

Why do payers change policies for code Z86.73?