L40.59 Insurance Policy Changes

ICD-10 L40.59 is officially defined as "Other psoriatic arthropathy." code L40.59 is referenced in 9 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code L40.59 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026High impact
State and School Employees' Health Insurance Plan - Anti-Rheumatic Biologicals
Avsola (infliximab-axxq) and Renflexis (infliximab-abda) are medical covered agents for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and Cimzia is a medical covered agent for polyarticular juvenile idiopathic arthritis. Actemra (tocilizumab) and Tofidence (tocilizumab-bavi) are not covered on the State Health Plan Medical Drug Formulary. Requested agents may be considered medically necessary when the initial criteria are met, including an FDA-labeled indication, a specialist prescriber or consultation, failure of at least one conventional DMARD after at least a 3-month duration of therapy (or intolerance to all conventional agents), and latent TB testing when the prescribing information requires it.
Aetna · Identified Aug 19, 2026Medium impact
Zoledronic Acid (CPB 0524, reviewed 2026-02-12)
Aetna's clinical policy bulletin covers zoledronic acid for commercial medical plans. Zoledronic acid 5 mg (Reclast or generic) is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget's disease of bone, and treatment-related bone loss in men with prostate cancer receiving androgen deprivation therapy, when the listed criteria are met. Zoledronic acid 4 mg (formerly branded Zometa) is considered medically necessary for bone metastases from a solid tumor, certain breast cancer indications, hypercalcemia of malignancy, Langerhans cell histiocytosis with bone disease, multiple myeloma, and systemic mastocytosis with osteopenia or osteoporosis. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Secukinumab (Cosentyx) (CPB 0905, reviewed 2026-08-11)
Aetna covers secukinumab (Cosentyx) for commercial medical plans when the criteria for the specific indication are met. The covered indications are plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, enthesitis-related arthritis, and hidradenitis suppurativa, and each has its own prior treatment and disease severity criteria. Continuation of therapy requires a positive clinical response, and intravenous Cosentyx requires precertification.
Aetna · Identified Aug 16, 2026Medium impact
Risankizumab-rzaa (Skyrizi) (CPB 1009, reviewed 2026-07-01)
Aetna's Clinical Policy Bulletin for risankizumab-rzaa (Skyrizi) covers the drug for commercial medical plans when the member meets the listed criteria for plaque psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis. Precertification is required for intravenous Skyrizi, and the drug must be prescribed by or in consultation with a dermatologist (plaque psoriasis), a rheumatologist or dermatologist (psoriatic arthritis), or a gastroenterologist (Crohn's disease and ulcerative colitis). Aetna considers all other indications experimental, investigational, or unproven, and considers concomitant use with another biologic or targeted synthetic drug for the same indication experimental.
Aetna · Identified Aug 15, 2026Medium impact
Golimumab (Simponi and Simponi Aria) (CPB 0790, reviewed 2026-07-31)
Golimumab is covered for commercial plans when the criteria for the requested form and indication are met. Intravenous Simponi Aria is covered for moderately to severely active rheumatoid arthritis given with methotrexate, active psoriatic arthritis, active ankylosing spondylitis, articular juvenile idiopathic arthritis in members 2 years of age or older, and moderate or severe immune checkpoint inhibitor-related inflammatory arthritis. Subcutaneous Simponi is covered for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, moderately to severely active ulcerative colitis, and immune checkpoint inhibitor-related inflammatory arthritis. Concomitant use with another biologic or targeted synthetic drug for the same indication is considered experimental, investigational or unproven, as are Behcet's disease, Crohn's disease, non-infectious uveitis, panuveitis, posterior uveitis and scleritis for intravenous golimumab, plus asthma and sarcoidosis for subcutaneous golimumab.
Aetna · Identified Aug 13, 2026Medium impact
Etanercept (CPB 0315, reviewed 2026-07-08)
Aetna's Clinical Policy Bulletin 0315 considers etanercept (Enbrel) medically necessary for rheumatoid arthritis, articular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, plaque psoriasis, reactive arthritis, hidradenitis suppurativa, graft versus host disease, Behcet's disease and immune checkpoint inhibitor-related toxicity when the listed criteria are met. Initial criteria differ by indication and include prior treatment with other drugs for several of them, and continuation of therapy requires a positive clinical response. Aetna considers all other indications experimental, investigational, or unproven, including concomitant use with another biologic or targeted synthetic drug for the same indication.
Aetna · Identified Aug 12, 2026Medium impact
Abatacept (Orencia) (CPB 0720, reviewed 2026-07-01)
For commercial plans, Aetna requires precertification of intravenous abatacept (Orencia IV) for all participating providers and members in applicable plan designs, and considers IV Orencia medically necessary only for members with a contraindication, intolerance or ineffective response to the listed equivalent targeted immune modulators. Abatacept is considered medically necessary for initial approval in rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, prophylaxis of acute graft versus host disease, chronic graft versus host disease, and immune checkpoint inhibitor-related myocarditis when the stated criteria are met, and continuation requires a positive clinical response. All other indications, and concurrent use with another biologic or targeted synthetic drug for the same indication, are considered experimental, investigational, or unproven.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA08.174, Secukinumab (Cosentyx®) for Intravenous Use
Independence Blue Cross reissued MA08.174 on 05/27/2026 with no substantive changes to secukinumab (Cosentyx) intravenous coverage criteria for psoriatic arthritis, ankylosing spondylitis, and nonradiographic axial spondyloarthritis. This is a routine policy reaffirmation confirming the company's continuing coverage position; billing teams should verify current authorization requirements remain unchanged.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA08.174, Secukinumab (Cosentyx®) for Intravenous Use
Independence Blue Cross reissued MA08.174 on 05/27/2026 with no substantive changes to coverage criteria for secukinumab (Cosentyx) intravenous use. This is a routine policy reaffirmation communicating the company's continuing position on coverage for psoriatic arthritis, ankylosing spondylitis, and nonradiographic axial spondyloarthritis in Medicare Advantage members. No billing workflow changes are required.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code L40.59?

There are 9 tracked policy changes affecting code L40.59, including updates from Blue Cross & Blue Shield of Mississippi, Aetna, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code L40.59?

Payers that have issued tracked updates for code L40.59 include: Blue Cross & Blue Shield of Mississippi, Aetna, Independence Blue Cross.

How do I get notified when code L40.59 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code L40.59. 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 L40.59?

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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State and School Employees' Health Insurance Plan - Anti-Rheumatic Biologicals

Zoledronic Acid (CPB 0524, reviewed 2026-02-12)

Secukinumab (Cosentyx) (CPB 0905, reviewed 2026-08-11)

Risankizumab-rzaa (Skyrizi) (CPB 1009, reviewed 2026-07-01)

Golimumab (Simponi and Simponi Aria) (CPB 0790, reviewed 2026-07-31)

Etanercept (CPB 0315, reviewed 2026-07-08)

Abatacept (Orencia) (CPB 0720, reviewed 2026-07-01)

MA08.174, Secukinumab (Cosentyx®) for Intravenous Use

MA08.174, Secukinumab (Cosentyx®) for Intravenous Use

What insurance policy changes affect code L40.59?

Which payers have updated policy for code L40.59?

How do I get notified when code L40.59 policy changes?

Why do payers change policies for code L40.59?