What insurance policy changes affect code A49.02?

There are 2 tracked policy changes affecting code A49.02, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code A49.02?

Payers that have issued tracked updates for code A49.02 include: Aetna.

How do I get notified when code A49.02 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code A49.02. 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 A49.02?

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

A49.02 Insurance Policy Changes

ICD-10 A49.02 is officially defined as "Methicillin resistant Staphylococcus aureus infection, unspecified site." code A49.02 is referenced in 2 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 A49.02 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

Aetna · Identified Aug 17, 2026Medium impact
Afamelanotide (Scenesse) (CPB 0962, reviewed 2025-12-09)
Aetna considers afamelanotide (Scenesse) medically necessary for biochemically confirmed erythropoietic protoporphyria in adult members whose protoporphyrin level is above the lab reference range in peripheral red blood cells. Aetna considers continuation of afamelanotide therapy medically necessary for adult members with that indication who are experiencing benefit from therapy while receiving it. Aetna considers all other indications experimental, investigational, or unproven, including inhibition of drug-resistant pathogenic bacteria such as MRSA and treatment of acute ischemic stroke, and this policy applies to commercial medical plans.
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.

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Afamelanotide (Scenesse) (CPB 0962, reviewed 2025-12-09)

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

What insurance policy changes affect code A49.02?

Which payers have updated policy for code A49.02?

How do I get notified when code A49.02 policy changes?

Why do payers change policies for code A49.02?