A9153 Insurance Policy Changes

Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)

Aetna has issued a new medical policy (CPB 0226, effective 2026-04-23) establishing coverage criteria for hospitalization to initiate ketogenic diet therapy. Coverage is limited to children under 18 with intractable seizures who have failed adequate anti-convulsant trials, plus patients with specific metabolic disorders (glucose transporter protein type 1 deficiency or pyruvate dehydrogenase complex deficiency). All other indications including adult epilepsy, autism, cancer, migraine, and psychiatric conditions are designated as unproven/experimental and not covered.