ICD-10 M19.279 is officially defined as "Secondary osteoarthritis, unspecified ankle and foot." code M19.279 is referenced in 6 tracked payer policy changes from Health Net, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code M19.279 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Health Net updated multiple medical policies in Q4 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties including oxygen therapy, allergy testing, bariatric surgery, wound care, and various diagnostic procedures.
Health Net updated multiple medical policies in Q4 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties including oxygen therapy, allergy testing, bariatric surgery, and wound care. Most changes involve revised medical necessity criteria and updated CPT/ICD-10 codes that require immediate attention for proper billing and authorization processes.
CalViva Health updated multiple medical policies for Q4 2020 affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties. Key changes include revised oxygen therapy criteria, new ambulatory surgery center redirection requirements, updated bariatric surgery protocols, and modified coverage for various diagnostic and therapeutic services.
Aetna's Clinical Policy Bulletin 0645 covers total ankle arthroplasty with an FDA-cleared implant for severe ankle arthritis when a set of criteria is met, including at least 6 months of documented conservative care with in-person physical therapy, and covers revision for a failed prosthesis. It treats custom implants, trans-fibular replacement, total talar replacement and intraoperative infection frozen-section analysis as experimental. The source shows a review date of 2026-09-14 but states no effective date, and this is an older source first detected by PolicyChanges on 2026-10-05, so treat it as historical material.
Aetna considers pedobarography (foot pressure studies) experimental, investigational, or unproven, because the medical literature does not contain reliable evidence that it improves diagnosis and management of foot conditions or health outcomes. CPT 96001, comprehensive computer-based motion analysis with dynamic plantar pressure measurements during walking, is listed as not covered for the indications in this policy. Related CPT codes include motion analysis, surface electromyography and physician interpretation, related HCPCS codes include ankle-foot orthoses and orthopedic shoes, and ICD-10 codes for diabetes with neurological complications, pressure ulcers of the ankle and heel, and osteoarthritis of the ankle and foot are listed as not covered for these indications.
Total ankle replacement using an FDA-approved device may be considered medically necessary in skeletally mature patients with moderate to severe ankle (tibiotalar) pain that limits daily activity and who have arthritis in adjacent joints (subtalar or midfoot), severe arthritis or arthrodesis of the contralateral ankle, or inflammatory (e.g., rheumatoid) arthritis. Total ankle replacement is considered investigational for all other indications. Absolute contraindications include extensive avascular necrosis of the talar dome, compromised bone stock or soft tissue, severe malalignment (e.g., >15 degrees) not correctable by surgery, active ankle joint infection, peripheral vascular disease, and Charcot neuroarthropathy.
Watch M19.279
Get one email when a payer policy names M19.279, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.