What insurance policy changes affect code M20.40?

There are 3 tracked policy changes affecting code M20.40, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code M20.40?

Payers that have issued tracked updates for code M20.40 include: Aetna.

How do I get notified when code M20.40 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code M20.40. 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 M20.40?

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

M20.40 Insurance Policy Changes

ICD-10 M20.40 is officially defined as "Other hammer toe(s) (acquired), unspecified foot." code M20.40 is referenced in 3 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 M20.40 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 3, 2026Low impact
Hammertoe Repair (CPB 0636, reviewed 2026-09-11)
Aetna's Clinical Policy Bulletin 0636 sets out the criteria it uses to consider hammertoe repair medically necessary, including radiographs, proof of skeletal maturity, and at least 3 months of documented conservative treatment with persistent pain and difficulty walking, plus one of the listed indications. It treats the named fixation implants, plantar plate repair, and hammertoe repair that does not meet the criteria as experimental. The source shows a review date of 2026-09-11 but states no effective date, so treat it as historical material and confirm current applicability.
Aetna · Identified Aug 16, 2026Low impact
Hammertoe Repair (CPB 0636, reviewed 2025-12-11)
This is Aetna's Clinical Policy Bulletin 0636 on hammertoe repair, reviewed 2025-12-11, so it is historical material from an older source. It considers surgical repair medically necessary for members who are skeletally mature or 18 or older when radiographic confirmation, persistent pain and difficulty walking after at least 3 months of conservative treatment, and a listed indication are documented. It considers fixation implants and plantar plate repair experimental, investigational or unproven, and the source does not state an effective date or describe what changed.
Aetna · Identified Aug 15, 2026Low impact
Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2025-10-02)
This is Aetna Clinical Policy Bulletin 0649, reviewed October 2, 2025 and first found by PolicyChanges in August 2026, so it is historical material and the current version should be confirmed before acting. Aetna covers extracorporeal shock-wave therapy only for calcific tendinopathy of the shoulder with a calcium deposit of at least 1 cm lasting 6 months or more after conservative care has failed, and lists dozens of other musculoskeletal, wound and medical uses as experimental, investigational or unproven.

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Hammertoe Repair (CPB 0636, reviewed 2026-09-11)

Hammertoe Repair (CPB 0636, reviewed 2025-12-11)

Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2025-10-02)

What insurance policy changes affect code M20.40?

Which payers have updated policy for code M20.40?

How do I get notified when code M20.40 policy changes?

Why do payers change policies for code M20.40?