D45 Insurance Policy Changes

ICD-10 D45 is officially defined as "Polycythemia vera." code D45 is referenced in 11 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D45 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Mar 19, 2026Medium impact
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms 2.02.53
Molecular testing for suspected myelofibrosis (MF) or essential thrombocythemia (ET) is medically necessary when the test is completed on blood or bone marrow, the patient presents with clinical, laboratory, or pathologic findings suggesting MF or ET, secondary causes have been evaluated, and a JAK2, MPL, or CALR mutation is tested for. Molecular testing for suspected polycythemia vera (PV) is medically necessary when the test is completed on blood or bone marrow, the patient presents with findings suggesting PV, evaluation for secondary causes has been completed, and the test is for JAK2 mutations. JAK2, MPL, and CALR testing is investigational in all other circumstances, including diagnosis of nonclassic myeloproliferative neoplasms and molecular phenotyping of patients with MPNs. Broad molecular panel testing is considered investigational.
Aetna · Identified Oct 5, 2026Medium impact
Therapeutic Phlebotomy (CPB 0652, reviewed 2026-09-25)
Aetna considers therapeutic phlebotomy medically necessary for erythrocytosis of undetermined etiology with a hematocrit of 55% or higher, hemochromatosis (including hereditary hemochromatosis), individuals receiving testosterone therapy with a hematocrit of 54% or higher (or hemoglobin of 180 g/L or higher), non-alcoholic fatty liver disease with hyperferritinemia, non-hereditary hemochromatosis iron overload with elevated hepatic iron concentration, polycythemia vera, polycythemia secondary to arteriovenous fistulae, cor pulmonale or cyanotic congenital heart disease (for hematocrit greater than 60%), porphyria cutanea tarda, and sickle cell crisis. The policy lists acute gouty arthritis, chronic hepatitis C, chronic urticaria, the common cold, hyperferritinemia in alcohol liver disease, hypertension, migraines, myeloproliferative disorders without polycythemia vera, and progressive multiple sclerosis as experimental, investigational or unproven for phlebotomy treatment. CPT 99195 (phlebotomy, therapeutic, separate procedure) is covered if the selection criteria are met.
Aetna · Identified Oct 4, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)
Aetna considers autologous hematopoietic cell transplantation medically necessary for adults 18 to 69 years old with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure. This applies when active interstitial lung disease is present with a forced vital capacity or diffusing capacity of the lung for carbon monoxide below 70% of predicted, or when previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, if there are none, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic hematopoietic cell transplantation experimental, investigational, or unproven for conditions including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, myasthenia gravis, type I diabetes mellitus, age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera, and thrombotic thrombocytopenic purpura.
Aetna · Identified Oct 3, 2026Medium impact
Interferons (CPB 0404, reviewed 2026-09-10)
Aetna's interferon policy covers Actimmune (interferon gamma-1b) for chronic granulomatous disease, mycosis fungoides/Sezary syndrome and severe malignant osteopetrosis, and considers all other indications experimental, investigational, or unproven. Pegasys (peginterferon alfa-2a) and Besremi (ropeginterferon alfa-2b-njft) each have their own list of covered indications, and several Besremi indications are covered only when Pegasys is unavailable. Aetna considers continuation of therapy medically necessary for members who are experiencing benefit, as evidenced by disease stability or disease improvement, and the Biojector 2000 needle-free injection system is considered a medically necessary alternative to needles for members with exacerbating-remitting MS who cannot safely self-inject due to tremors and decreased coordination.
Aetna · Identified Aug 18, 2026Medium impact
Therapeutic Phlebotomy (CPB 0652, reviewed 2025-12-08)
Aetna considers therapeutic phlebotomy medically necessary for erythrocytosis of undetermined etiology with hematocrit of 55% or higher, hemochromatosis including hereditary hemochromatosis, testosterone therapy when hematocrit is 54% or higher or hemoglobin is 180 g/L or higher, non-alcoholic fatty liver disease with hyperferritinemia, non-hereditary hemochromatosis iron overload with elevated hepatic iron concentration, polycythemia vera, porphyria cutanea tarda, and sickle cell crisis. Polycythemia secondary to arterio-venous fistulae, cor pulmonale, or cyanotic congenital heart disease is covered for persons with hematocrit greater than 60%. Aetna considers therapeutic phlebotomy experimental, investigational, or unproven for acute gouty arthritis, chronic hepatitis C as adjunctive therapy with interferon, chronic urticaria, the common cold, hyperferritinemia in alcohol liver disease, hypertension, migraines, myeloproliferative disorders without polycythemia vera, and progressive multiple sclerosis.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)
Aetna's Clinical Policy Bulletin 0606 covers hematopoietic cell transplantation for autoimmune diseases and other listed conditions. Aetna considers autologous transplant medically necessary for adults aged 18 to 69 with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure when either active interstitial lung disease with an FVC or DLCO below 70% of predicted is present, or previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, where none exist, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic transplant experimental, investigational or unproven for many autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, type 1 diabetes and myasthenia gravis, and for miscellaneous conditions such as age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera and thrombotic thrombocytopenic purpura.
Aetna · Identified Aug 17, 2026Medium impact
Genetic Counseling (CPB 0189, reviewed 2026-03-27)
Aetna considers genetic counseling medically necessary for listed pregnancy-related indications, including couples who are closely related genetically, familial cancer disorders, pregnant women with maternal age 35 years or greater at delivery, and parents of a child born with a genetic disorder or birth defect. Genetic counseling unrelated to pregnancy is covered when it is appropriate for, or provided with, medically necessary genetic testing in accordance with ACMG guidelines. Genetic counseling for all other indications is considered experimental, investigational or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction (CPB 0351, reviewed 2026-05-21)
Aetna considers flow cytometry for cell surface markers medically necessary for listed conditions, including abnormal tissue, bone marrow or blood histology suspicious for lymphoma, leukemia or myelodysplastic syndrome, multiple myeloma, paroxysmal nocturnal hemoglobinuria, primary immunodeficiencies, Sezary syndrome diagnosis, and T-cell monitoring for HIV infection and AIDS. Flow-cytometry-derived DNA ploidy or S-phase fraction is medically necessary only in localized cancers without metastatic disease, namely endometrial adenocarcinoma, gastric cancer, mediastinal neuroblastoma, medulloblastoma, ovarian carcinoma, partial hydatidiform mole, prostatic adenocarcinoma, renal cell adenocarcinoma and urinary bladder carcinoma, and only when the prognostic information will affect treatment decisions. Ektacytometry is medically necessary for red blood cell cytoskeleton and hydration disorders when red blood cell morphology does not provide a clear diagnosis. The red blood cell adhesion index for all indications, DNA ploidy or S-phase testing in breast, cervical, colorectal, non-small cell lung, small cell lung and pediatric intracranial tumors, and microfluidic flow adhesion assays for sickle cell disease are experimental, investigational or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Interferons (CPB 0404, reviewed 2026-06-09)
Aetna covers Actimmune (interferon gamma-1b) for chronic granulomatous disease, severe malignant osteopetrosis, and mycosis fungoides/Sezary syndrome, and considers all other indications experimental, investigational, or unproven. Aetna covers peginterferon alfa-2a (Pegasys) for adult T-cell leukemia/lymphoma, chronic hepatitis B for up to a total of 48 weeks, chronic hepatitis C, chronic hepatitis E in liver transplant recipients who meet the ribavirin criteria, and several myeloproliferative, mastocytosis, and lymphoma indications. Ropeginterferon alfa-2b-njft (Besremi) is covered for polycythemia vera and for several other indications when peginterferon alfa-2a (Pegasys) is unavailable.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms
JAK2 testing may be considered medically necessary to diagnose individuals with clinical, laboratory, or pathologic findings suggesting polycythemia vera, essential thrombocythemia, or primary myelofibrosis. MPL and CALR testing may be considered medically necessary to diagnose individuals with findings suggesting essential thrombocythemia or primary myelofibrosis. JAK2, MPL, and CALR testing is considered investigational for nonclassic forms of myeloproliferative neoplasms, molecular phenotyping, and monitoring, management, or selecting treatment in myeloproliferative neoplasms.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Low impact
Phlebotomy, Therapeutic
This is a policy review for therapeutic phlebotomy coverage under BCBS Mississippi. The policy confirms coverage for specific blood disorders including polycythemia vera, hemochromatosis, and related conditions. No changes were made to coverage criteria or billing codes.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D45?

There are 11 tracked policy changes affecting code D45, including updates from Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D45?

Payers that have issued tracked updates for code D45 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code D45 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D45. 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 D45?

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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JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms 2.02.53

Therapeutic Phlebotomy (CPB 0652, reviewed 2026-09-25)

Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)

Interferons (CPB 0404, reviewed 2026-09-10)

Therapeutic Phlebotomy (CPB 0652, reviewed 2025-12-08)

Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)

Genetic Counseling (CPB 0189, reviewed 2026-03-27)

Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction (CPB 0351, reviewed 2026-05-21)

Interferons (CPB 0404, reviewed 2026-06-09)

JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms

Phlebotomy, Therapeutic

What insurance policy changes affect code D45?

Which payers have updated policy for code D45?

How do I get notified when code D45 policy changes?

Why do payers change policies for code D45?