M45.AB Insurance Policy Changes

ICD-10 M45.AB is officially defined as "Non-radiographic axial spondyloarthritis of multiple sites in spine." code M45.AB is referenced in 5 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 M45.AB is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective Jan 7, 2026Medium impact
Therapeutic Drug Monitoring of Anti-Tumor Necrosis Factor Blocking Agents (CPB 1091, reviewed 2026-10-16)
Aetna considers measurement of antidrug antibodies and or serum drug levels for adalimumab, certolizumab, golimumab, or infliximab medically necessary for members with Crohn's disease or ulcerative colitis when there is documentation of a loss of response to one of these medications, or for proactive monitoring in members 21 years of age or younger with a confirmed diagnosis of IBD. Aetna considers serum antibody measurements for anti-TNF therapies experimental, investigational, or unproven for all other indications, such as psoriasis, psoriatic arthritis, rheumatoid arthritis, spondyloarthritis, and uveitis. Anti-histone antibody measurement for monitoring infliximab and DNA or mRNA biomarker measurement for predicting therapeutic response in IBD are also considered experimental, investigational, or unproven.
Aetna · Identified Oct 4, 2026Medium impact
Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation (CPB 0599, reviewed 2026-09-18)
Autologous skeletal myoblast transplantation, intra-coronary and intra-myocardial autologous bone marrow cell transplantation, and intra-arterial or intra-muscular autologous mononuclear bone marrow cell transplantation are considered experimental, investigational, or unproven because effectiveness has not been established. Autologous or allogeneic bone marrow-derived mesenchymal stem cell transplantation is likewise considered experimental, investigational, or unproven for conditions including acute myocardial infarction, diabetes, multiple sclerosis, knee osteoarthritis, spinal cord injury, rheumatoid arthritis, Crohn's disease, and peripheral nerve repair. CPT codes 0263T, 0264T, 0265T, 38240, and 38241 and HCPCS code C9782 are listed as not covered for the listed indications, and the ICD-10 codes for those indications are listed as not covered for these services.
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 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 12, 2026Medium impact
Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)
Aetna considers certolizumab pegol (Cimzia) medically necessary for commercial medical plans only for members who have a contraindication, intolerance or ineffective response to the listed lower cost targeted immune modulators, with waived trial requirements for members who are pregnant or breastfeeding. Precertification is required of all Aetna participating providers and members in applicable plan designs, and the medication must be prescribed by or in consultation with a specialist such as a rheumatologist, gastroenterologist, dermatologist or oncologist depending on the indication. Aetna considers Cimzia experimental, investigational or unproven for concomitant use with other biologics or targeted synthetic drugs for the same indication and for Behcet's disease, microscopic colitis, ocular inflammation/uveitis, sarcoidosis and severe asthma.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code M45.AB?

There are 5 tracked policy changes affecting code M45.AB, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code M45.AB?

Payers that have issued tracked updates for code M45.AB include: Aetna.

How do I get notified when code M45.AB policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code M45.AB. 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 M45.AB?

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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Therapeutic Drug Monitoring of Anti-Tumor Necrosis Factor Blocking Agents (CPB 1091, reviewed 2026-10-16)

Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation (CPB 0599, reviewed 2026-09-18)

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

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

Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)

What insurance policy changes affect code M45.AB?

Which payers have updated policy for code M45.AB?

How do I get notified when code M45.AB policy changes?

Why do payers change policies for code M45.AB?